Abstract
BackgroundSelf-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services.We aimed to investigate (i) if a dataset of ED presentations could be produced using a combination of routinely collected clinical and administrative data and (ii) to validate this dataset against another one produced using methods similar to those used in previous studies.MethodsUsing the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared.ResultsThere were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 % and 76 % of all attendances respectively and both detected 82 % of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records.ConclusionsIt was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed.
Highlights
Self-harm is a significant public health concern in the UK
In the sample coded by both coders, testing of inter-rater reliability found that the kappa statistic for inter-rater reliability in identifying the presence of self-harm was 0.85; that for identifying the type of self-harm was 0.87
When the available data were compared we found no significant differences in sex, age, ethnicity or marital status distribution (p > 0.1 for all comparisons)
Summary
Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. Available data for inpatient admissions following self-harm miss the majority of cases presenting to services. Self-harm is a significant public health issue in the UK [1] It is strongly associated with the presence of mental disorders [2] and is the single strongest risk factor for future suicide [3]. Treatment of the consequences of self-harm places a significant burden on health services. HES are administrative data on all admissions, outpatient appointments and Emergency Department (ED) attendances at National Health Service (NHS) hospitals in England. Rates of admission related to self-harm are used as the indicator to represent mental health and well-being in Public Health England’s Area Health Profiles [4], and have been used to study geographical variations in self-harm [5, 6]
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