TY  - JOUR
PY  - 2018//
TI  - Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data
JO  - BMC psychiatry
A1  - Steeg, Sarah
A1  - Quinlivan, Leah
A1  - Nowland, Rebecca
A1  - Carroll, Robert
A1  - Casey, Deborah
A1  - Clements, Caroline
A1  - Cooper, Jayne
A1  - Davies, Linda
A1  - Knipe, Duleeka
A1  - Ness, Jennifer
A1  - O'Connor, Rory C.
A1  - Hawton, Keith
A1  - Gunnell, David
A1  - Kapur, Nav
SP  - e113
EP  - e113
VL  - 18
IS  - 1
N2  - BACKGROUND: Risk scales are used widely in the management of patients presenting to hospital following self-harm. However, there is evidence that their diagnostic accuracy in predicting repeat self-harm is limited. Their predictive accuracy in population settings, and in identifying those at highest risk of suicide is not known. <br><br>METHOD: We compared the predictive accuracy of the Manchester Self-Harm Rule (MSHR), ReACT Self-Harm Rule (ReACT), SAD PERSONS Scale (SPS) and Modified SAD PERSONS Scale (MSPS) in an unselected sample of patients attending hospital following self-harm. Data on 4000 episodes of self-harm presenting to Emergency Departments (ED) between 2010 and 2012 were obtained from four established monitoring systems in England. Episodes were assigned a risk category for each scale and followed up for 6 months. <br><br>RESULTS: The episode-based repeat rate was 28% (1133/4000) and the incidence of suicide was 0.5% (18/3962). The MSHR and ReACT performed with high sensitivity (98% and 94% respectively) and low specificity (15% and 23%). The SPS and the MSPS performed with relatively low sensitivity (24-29% and 9-12% respectively) and high specificity (76-77% and 90%). The area under the curve was 71% for both MSHR and ReACT, 51% for SPS and 49% for MSPS. Differences in predictive accuracy by subgroup were small. The scales were less accurate at predicting suicide than repeat self-harm. <br><br>CONCLUSIONS: The scales failed to accurately predict repeat self-harm and suicide. The findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk.<p />  <p>Language: en</p>
LA  - en
SN  - 1471-244X
UR  - http://dx.doi.org/10.1186/s12888-018-1693-z
ID  - ref1
ER  -