tran-riskstratificationusing-2014.pdf (279.9 kB)
Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments
journal contribution
posted on 2014-03-14, 00:00 authored by Truyen TranTruyen Tran, Wei LuoWei Luo, Quoc-Dinh Phung, Richard HarveyRichard Harvey, Michael BerkMichael Berk, Lee KennedyLee Kennedy, Svetha VenkateshSvetha VenkateshBackground: To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1-6month risk. Methods: 7,399 patients undergoing suicide risk assessment were followed up for 180days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator). Results: In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3months (AUC 0.58, 95% CIs: 0.50 - 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 - 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83). Conclusion: Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.
History
Journal
BMC psychiatryVolume
14Issue
1Pagination
1 - 9Publisher
BioMed CentralLocation
London, Eng.Publisher DOI
eISSN
1471-244XLanguage
engPublication classification
C1 Refereed article in a scholarly journal; C Journal articleCopyright notice
2014, BioMed CentralUsage metrics
Categories
No categories selectedKeywords
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC