Non-suicidal self-injury at a Canadian paediatric emergency department

IF 2 4区医学 Q2 EMERGENCY MEDICINE

Canadian Journal of Emergency Medicine Pub Date : 2024-04-02 DOI:10.1007/s43678-024-00657-9

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Abstract

Objective

Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury.

Methods

This is a health records review of patients aged 12–18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017–May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen’s Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests.

Results

We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen’s Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3–75.4) and negative predictive value of 71.2% (95% CI 68.2–74.0). Cutting was the most common method of non-suicidal self-injury (80.3%).

Conclusion

Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients’ coping strategies.

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加拿大儿科急诊室发生的非自杀性自伤事件

摘要目的我们的首要目标是确定分诊时记录的非自杀性自伤与随后进行的心理健康评估之间的一致性。次要目标是描述报告非自杀性自我伤害的患者。方法这是对 2017 年 6 月 1 日至 2018 年 5 月 31 日在急诊室就诊的 12-18 岁患者进行的健康记录审查，这些患者的健康记录上有一份急诊精神健康分诊表。我们排除了诊断为自闭症谱系障碍或精神分裂症的患者。我们从心理健康分诊表、急诊心理健康和成瘾服务评估表以及自杀和风险评估量表中抽取了数据。我们计算了科恩卡帕系数（Cohen's Kappa coefficient）、灵敏度（sensitivity）和负预测值（negative predictive value），以描述各表格的一致程度以及分诊在识别非自杀性自伤方面的表现。我们使用 t 检验、Wilcoxon 秩和检验和卡方检验对报告了非自杀性自伤的人群和未报告的人群进行了比较。结果我们对 955 名急诊就诊者进行了筛查，共纳入 914 名急诊就诊者，其中 558 人（58.4%）报告了非自杀性自残史。与未报告非自杀性自我伤害的患者（45.8%，n = 163）相比，报告非自杀性自我伤害的患者中女性明显较多（82.1%，n = 458）。64.7%的患者在分诊和详细心理健康评估中报告了非自杀性自伤行为（科恩卡帕系数0.6）；分诊的灵敏度为71.5%（95% CI 67.3-75.4），阴性预测值为71.2%（95% CI 68.2-74.0）。切割是最常见的非自杀性自伤方式（80.3%）。结论与专业心理健康团队的详细评估相比，分流筛查在识别非自杀性自我伤害方面的效果一般。在我们的急诊室，超过半数有心理健康相关问题的儿童和青少年都有非自杀性自伤的病史，其中大部分是女性。这一症状对于确定患者的应对策略非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Emergency Medicine Medicine-Emergency Medicine

CiteScore

2.90

自引率

12.50%

发文量

171

审稿时长

>12 weeks

期刊介绍： CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.