A clinical tool for assessing risk after self-harm

Ann Emerg Med. 2006 Oct;48(4):459-66. doi: 10.1016/j.annemergmed.2006.07.944.


Study objective: Our aim is to develop a risk-stratification model for use by emergency department (ED) clinical staff in the assessment of patients attending with self-harm.

Methods: Participants were patients who attended 5 EDs in Manchester and Salford, England, after self-harm between September 1, 1997, and February 28, 2001. Social, demographic, and clinical information was collected for each patient at each attendance. With data from the Manchester and Salford Self-Harm Project, a clinical decision rule was derived by using recursive partitioning to discriminate between patients at higher and lower risk of repetition or subsequent suicide occurring within 6 months. Data from 3 EDs were used for the derivation set. The model was validated with data from the remaining 2 EDs.

Results: Data for 9,086 patients who presented with self-harm were collected during this study period, including 17% that reattended within 6 months and 22 patients who died by suicide within 6 months. A 4-question rule, with a sensitivity of 94% (92.1-95.0% [95% confidence interval]) and specificity of 25% (24.2-26.5% [95% confidence interval]), was derived to identify patients at higher risk of repetition or suicide.

Conclusion: Application of this simple, highly sensitive rule may facilitate assessment in the ED and help to focus psychiatric resources on patients at higher risk.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Benzodiazepines / poisoning
  • Case Management
  • Chi-Square Distribution
  • Child
  • Decision Trees
  • Drug Overdose
  • Emergency Service, Hospital*
  • Emergency Services, Psychiatric*
  • England / epidemiology
  • Female
  • Humans
  • Male
  • Medical History Taking
  • Middle Aged
  • Models, Theoretical
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Risk
  • Risk Assessment
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / prevention & control
  • Self-Injurious Behavior / psychology
  • Sensitivity and Specificity
  • Suicide Prevention*
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data*
  • Surveys and Questionnaires*
  • Urban Population
  • Wounds, Stab / epidemiology


  • Benzodiazepines