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首页> 外文期刊>BMC Psychiatry >Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data
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Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data

机译：预测重复性自残和自杀的风险量表的准确性：使用常规临床数据进行的多中心，人群水平的队列研究

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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. 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. 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. 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.
机译：风险量表被广泛用于自我伤害后就诊的患者管理。但是，有证据表明，它们在预测重复性自我伤害方面的诊断准确性有限。他们在人群中的预测准确性以及在确定自杀风险最高的人群中的预测准确性尚不清楚。我们比较了曼彻斯特自我防卫规则（MSHR），ReACT自我防卫规则（ReACT），SAD PERSONS量表（SPS）和改良SAD PERSONS量表（MSPS）的预测准确性，这些数据来自于未选择的自选住院患者危害。从英格兰的四个已建立的监测系统中获得了2010年至2012年间向急诊部门（ED）呈现的4000次自残事件的数据。将每个等级的情节划分为风险类别，并随访6个月。基于发作的重复率为28％（1133/4000），自杀发生率为0.5％（18/3962）。 MSHR和ReACT具有高灵敏度（分别为98％和94％）和低特异性（15％和23％）。 SPS和MSPS的灵敏度相对较低（分别为24-29％和9-12％）和高特异性（76-77％和90％）。 MSHR和ReACT的曲线下面积均为71％，SPS为51％，MSPS为49％。各亚组的预测准确性差异很小。量表在预测自杀上的准确性不如重复自残。量表未能准确预测重复的自残和自杀。该发现支持现有的临床指导，而不是仅使用风险分类量表来确定治疗或预测未来风险。

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