Query purpose:
This query is intended to identify visits in the emergency department (ED) with diagnostic codes and/or chief complaints associated with a broad range of self-harm injuries and/or behavior. This includes codes (including ICD-10-CM code R45.88 which may or may not co-exist with a self-harm injury code or self-harm text) and text associated with self-harm (e.g., intentional poisoning, intentional self-harm by handgun discharge, nonsuicidal self-harm), regardless of suicidal intention.
How it was developed:
Wisconsin created and tested the first version of the query with a result of 93% PPV. The original definition was shared with four states that conducted testing (WA, KS, VT, and CO). A visit was confirmed as intentional self-harm by supportive narrative with and without corresponding self-harm codes OR it was confirmed if there was a self-harm code with or without narrative to support the code inclusion. A visit was determined false or ruled out if it was not related to self-harm (such as follow-up or sequalae visits for previous self-harm, or mental health visits or check-ins with no self-harm injury or reference to self-harm).
How it works:
Chief Complaint History and Discharge Diagnosis Parsed. Inclusion criteria attempts to capture all diagnoses of self-harm and keywords/phrases related to self-harm. Exclusion criteria removes common phrases that are not associated with self-harm and denials of self-harm or suicide attempt.
Plain language syntax description:
The Chief Complaint History field (also labeled as Chief Complaint Updates when
exported from ESSENCE) and the Discharge Diagnosis Parsed field are used to query both the discharge diagnosis codes and chief complaint free text, with exclusions applied, when necessary, to develop the syndrome definition.
- Inclusion based on discharge diagnosis codes:
- The visit is included if it contains:
- A discharge diagnosis code of suicide attempt (that is, T14.91A or SNOMED code indicating suicide attempt) OR,
- A discharge diagnosis code of self-harm injury, initial encounter OR,
- A discharge code of R4588 (nonsuicidal self-harm; this may or may not present with an initial injury code)
- There are no exclusion terms applied to the above
- The visit is included if it contains:
- Inclusion based on chief complaint terms for suicide attempt or self-harm:
- The visit is included if it contains:
- Chief complaint terms for suicide attempt
OR - Chief complaint terms for self-harm
- Chief complaint terms for suicide attempt
- The above must exclude:
- Concurrent chief complaint terms denying intention to self-harm or attempt suicide.
- Concurrent chief complaint terms associated with hanging objects, accidentally hurting oneself, unintentional overdose, or shooting pain.
- The visit is included if it contains:
For consideration:
This query has been restricted to focus on data from 2016 onward as it does not include ICD-9-CM codes. It is not possible to capture all variations of keywords and phrases that might be associated with self-harm as these may differ by jurisdiction and new phrases may appear over time. Additionally, it is difficult to capture all possible exclusions though we have tried to identify as many as we could (for instance, exclusion of hanging clothing or hanging deer).
(,^;T45AX2A^,OR,^;R4588^,OR,^;T1491XA^,OR,^;82313006;^,OR,^;891003;^,OR,^;44301001;^,OR,^;53846008;^,OR,^;55554002;^,OR,^;461211000124103;^,OR,^;86849004;^,OR,^;269725004;^,OR,^;274228002;^,OR,^;287181000;^,OR,^;287182007;^,OR,^;287190007;^,OR,^;460991000124106;^,OR,^;288311002;^,OR,^;287185009;^,OR,^;287183002;^,OR,^;287184008;^,OR,^;287186005;^,OR,^;36153001;^,OR,^;269808005;^,OR,^;460981000124108;^,OR,^;461181000124102;^,OR,^;461201000124101;^,OR,^;461131000124103;^,OR,^;461161000124107;^,OR,^;461111000124109;^,OR,^;461151000124105;^,OR,^;440144004;^,OR,^;370908002;^,OR,^;287194003;^,OR,^;287188006;^,OR,^;287192004;^,OR,^;287193009;^,OR,^;287195002;^,OR,^;287191006;^,OR,^;78070009;^,OR,^;287189003;^,OR,^;23546003;^,OR,^;461271000124107;^,OR,^;X7[1-9]___A;^,OR,^;X8[0-3]___A;^,OR,^;T3[6-9][X0-9][X0-9]2A;^,OR,^;T[4-5][0-9][X0-9][X0-9]2A;^,OR,^;T6[0-5][X0-9][X0-9]2A;^,OR,^;T71[X0-9][X0-9]2A;^,OR,^;T3[6-9][X0-9]2XA;^,OR,^;T[4-5][0-9][X0-9]2XA;^,OR,^;T6[0-5][X0-9]2XA;^,OR,^;T50[ABZ][129]2A;^,OR,^;248073004;^,OR,^;225045006;^,OR,^;307578000;^,OR,^;225050000;^,OR,^;225049000;^,OR,^;224946001;^,OR,^;224945002;^,OR,^;224947005;^,OR,^;284759005;^,OR,^;224949008;^,OR,^;224948000;^,),OR,(,^suicidal attem[pt]^,OR,^suicide attem[pt]^,OR,(,(,^attem[pt]^,OR,^try^,ANDNOT,(,^[a-z]try^,or,^try[a-z]^,),OR,^tried^,ANDNOT,(,^[a-z]tried^,or,^tried[a-z]^,),OR,^trying^,ANDNOT,^[a-z]trying^,OR,^intentional^,ANDNOT,(,^not intentional^,OR,^unintentional^,),OR,^commit^,OR,^comit^,),and,(,^kill^sel[FV]^,OR,^end life^,OR,^end h[ie][sr] life^,OR,^end their life^,OR,^SU[SC]CIDE^,OR,^SUI[SC]IDE^,OR,^SIU[CS]IDE^,OR,^SU[SC][IU]DE^,OR,^hang^,ANDNOT,^[a-z]hang^,OR,^shoot^,OR,^overdose^,OR,^OD^,ANDNOT,(,^[a-z]OD^,or,^OD[a-z]^,),OR,^poisoning^,ANDNOT,^food poisoning^,OR,^poison ingestion^,),),OR,(,^intentional^,ANDNOT,(,^not intentional^,OR,^unintentional^,),AND,(,^cut^,ANDNOT,^[a-z]cut^,OR,^lacera^,ANDNOT,^[a-z]lacera^,OR,^hurt^sel[fv]^,),),OR,(,^self[- ]injury^,OR,^self[- ]inflicted harm^,OR,^harm to self^,OR,^Self[- ]Directed Violence^,OR,^Self[- ]harm^,OR,^selfharm^,),),ANDNOT,(,^nonsuicidal^,OR,^NO ATTEM[PT]^,OR,^NO ATEM[PT]^,OR,^NOT ATTEM[PT]^,OR,^NOT ATEM[PT]^,OR,^end of life^,OR,^end of battery life^,OR,^D[EN][EN]IE[SD]^attem[pt]^,OR,^deny^attem[pt]^,OR,^D[EN][EN]IE[SD]^atem[pt]^,OR,^deny^atem[pt],OR,^deny^suicid^,OR,^D[EN][EN]IE[SD]^suicid^,OR,^D[EN][EN]IE[SD]^self[ -]harm^,OR,^deny^self[ -]harm^,OR,^no self[ -]harm^,OR,^not self[ -]harm^,OR,^D[EN][EN]IE[SD]^selfharm^,OR,^deny^selfharm^,OR,^no selfharm^,OR,^not selfharm^,OR,^unintentional suicid^,OR,^accidental suicid^,OR,^non-suicid^,OR,^non suicid^,OR,^no suicid^,OR,^not suicid^,OR,^not a suicid^,OR,^not want^die^,OR,^not try^die^,OR,^not want^kill^sel[fv]^,OR,^D[EN][EN]IE[SD]^kill^sel[fv]^,OR,^DENY^kill^sel[fv]^,OR,^not try^kill^sel[fv]^,OR,^not try^end^life^,OR,^didn^t try^die^,OR,^didn^t try^kill^sel[fv]^,OR,^didn^t try^end^life^,OR,^wasn^t try^die^,OR,^wasn^t try^ kill^sel[fv]^,OR,^wasn^t try^end^life^,OR,^didn^t want^ die^,OR,^didn^t want^kill^sel[fv]^,OR,^didn^t want^end^life^,OR,^not want^ die^,OR,^not want^ kill^sel[fv]^,OR,^not want^end^life^,OR,^D[EN][EN]IE[SD]^harm^self^,OR,^deny^harm^self^,OR,^DENIE[SD] BEING SUICIDAL^,OR,^DID NOT INTEN[DT] TO KILL H^SEL[VF]^,OR,(,^hang^,ANDNOT,^[a-z]hang^,AND,(,^picture^,OR,^robe^,OR,^cloth^,OR,^deer^,OR,^curtain^,OR,^nail^,),),OR,^accidental^cut^h^sel[vf]^,OR,^accidental^hurt^h^sel[vf]^,OR,^unintentional^cut^h^sel[vf]^,OR,^unintentional^hurt^h^sel[vf]^,OR,^unintentional^overdose^,OR,^unintentional^OD^,OR,^shooting pain^,OR,^accidental^lacera^,OR,^accidental^,ANDNOT,^not accidental^,OR,^suture remov^,OR,(,^wound^,and,(,^complication^,or,^check^,or,^care^,or,^recheck^,or,^infection^,or,^infected^,or,^drainage^,or,^eval^,),),)