TY  - JOUR
PY  - 2017//
TI  - Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study
JO  - British journal of psychiatry
A1  - Quinlivan, Leah
A1  - Cooper, Jayne
A1  - Meehan, Declan
A1  - Longson, Damien
A1  - Potokar, John
A1  - Hulme, Tom
A1  - Marsden, Jennifer
A1  - Brand, Fiona
A1  - Lange, Kezia
A1  - Riseborough, Elena
A1  - Page, Lisa
A1  - Metcalfe, Chris
A1  - Davies, Linda
A1  - O'Connor, Rory C.
A1  - Hawton, Keith
A1  - Gunnell, David
A1  - Kapur, Nav
SP  - 429
EP  - 436
VL  - 210
IS  - 6
N2  - BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.<br><br>METHODA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.<br><br>RESULTSIn total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0-5) for the SAD PERSONS scale, to 97% (95% CI 93-99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2-47) for the Modified SAD PERSONS Scale to 47% (95% CI 41-53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50-0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69-0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P<0.001).<br><br>CONCLUSIONSRisk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.<br><br>© The Royal College of Psychiatrists 2017.<p />  <p>Language: en</p>
LA  - en
SN  - 0007-1250
UR  - http://dx.doi.org/10.1192/bjp.bp.116.189993
ID  - ref1
ER  -