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Self-Inflicted Injury-Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP-SI): a new surveillance tool for detecting self-inflicted injury events in emergency departments

  • Dylan Johnson
  • Robin Skinner
  • Mario Cappelli
  • Roger Zemek
  • Steven McFaull
  • Corrine Langill
  • Paula Cloutier
Quantitative Research
  • 22 Downloads

Abstract

Objectives

To assess the performance of the Canadian Hospitals Injury Reporting and Prevention Program’s newly developed self-harm surveillance tool (CHIRPP-SI) designed to improve emergency department (ED) hospital surveillance of youth self-inflicted injury (SI).

Methods

This was a prospective, single-centre cohort study from February 2015 to September 2015. Eligible participants were aged 6–17.99 years and presented to the ED with a primary mental health complaint. The frequency of SI cases was extracted from three data sources (CHIRPP-SI, medical chart, and the National Ambulatory Care Reporting System Metadata (NACRS)). Cohen’s kappa statistic was used to examine the level of agreement between data sources.

Results

Of the 250 participants who received a medical chart review, 70 completed the CHIRPP-SI. Of those who did not complete the CHIRPP-SI, 86% (n = 154) reported no SI related to their presentation, 12% (n = 22) declined to participate without specifying self-injury status, and 2% (n = 4) were unable to be interviewed prior to discharge. The three sources of surveillance data varied considerably; the medical chart captured the highest frequency of individuals reporting SI related to their ED visit (33.6%), followed by the CHIRPP-SI (28.0%), and the NACRS database (8.4%). The CHIRPP-SI captured the method of SI and the place of occurrence in 100% of individuals, and the bodily location harmed in 98.6% of individuals.

Conclusions

Study findings highlight the disparity between different sources of data, in relation to the capture of paediatric SI, presenting to hospital EDs. If greater details of SI events are to be identified, surveillance tools such as the CHIRPP-SI should be considered.

Keywords

Self-harm Self-injury Surveillance Administrative data Paediatrics Emergency department 

Résumé

Objectifs

Évaluer la performance de l’outil du Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT-BAI) pour améliorer la surveillance des blessures auto-infligées (BAI).

Méthode

Étude de cohorte prospective menée en 2015. Les participants admissibles étaient âgés de 6 à 17,99 ans et se sont présentés au service des urgences avec une plainte de santé mentale. La fréquence des présentations avec des BAI a été extraite de trois sources de données (SCHIRPT-BAI, dossier médical, système national d’information sur les soins ambulatoires (SNISA)). Le kappa de Cohen a été utilisé pour examiner l’accord entre les sources de données.

Résultats

Des 250 participants qui ont reçu une revue du dossier médical, 70 avaient complété le SCHIRPT-BAI. De ceux sans SCHIRPT-BAI, 86 % (n = 154) n’ont déclaré aucune BAI, 12 % (n = 22) ont refusé de participer et 2 % (n = 4) n’ont pas pu être interrogés avant leur décharge. Les trois sources de données varient considérablement; le dossier médical a saisi le plus grand nombre de personnes ayant signalé une BAI liée à leur visite (33,6 %), comparé à 28,0 % par le SCHIRPT-BAI et 8,4 % par le SNISA. Le SCHIRPT-BAI a saisi la méthode du BAI et le lieu de l’événement pour 100 % des individus, et l’emplacement de la blessure corporelle pour 98,6 % des individus.

Conclusion

Il existe une disparité entre les différentes sources de données quant à la capture des BAI pédiatriques au service des urgences. Le SCHIRPT-BAI pourrait être utilisé pour capturer de plus amples détails à propos des cas de BAI.

Mots-clés

Automutilation Surveillance Pédiatrie Département d’urgence Données administratives 

Notes

Funding

Funding for this study was provided by the Public Health Agency of Canada (PHAC).

Compliance with ethical standards

Conflict of interest

R. Skinner and S. McFaull are employees of PHAC. The other authors declare that they have no competing interests.

Ethics approval and consent to participate

The study received hospital Research Ethics Board Approval (CHEOREB#15/113X). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. Ali, S., Rosychuk, R., Dong, K., McGrath, P., & Newton, A. (2012). Temporal trends in pediatric mental health visits. Pediatr Emerg Care, 28(7), 620–625.  https://doi.org/10.1097/PEC.0b013e31825cf93b.CrossRefPubMedGoogle Scholar
  2. Bethell, J., & Rhodes, A. (2009). Identifying deliberate self-harm in emergency department data. Health Reports, 20(2), 35–42 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19728584.PubMedGoogle Scholar
  3. Bethell, J., Bondy, S., Lou, W., Guttmann, A., & Rhodes, A. (2013). Emergency department presentations for self-harm among Ontario youth. Can J Public Health, 104(2), 124–130.  https://doi.org/10.17269/CJPH.104.3715.CrossRefGoogle Scholar
  4. Borschmann, R., Becker, D., Coffey, C., Spry, E., Moreno-Betancur, M., Moran, P., et al. (2017). 20-year outcomes in adolescents who self-harm: a population-based cohort study. The Lancet Child & Adolescent Health.  https://doi.org/10.1016/S2352-4642(17)30007-X.CrossRefGoogle Scholar
  5. Canadian Institute for Health Information. (2014). Intentional self-harm among youth in Canada. Retrieved from https://www.cihi.ca/web/resource/en/info_child_harm_en.pdf.
  6. Canadian Institute for Health Information. (2015). Canadian coding standards for version 2015 ICD-10-CA and CCI. Retrieved from https://secure.cihi.ca/free_products/Coding standard_EN_web.pdf.
  7. Clements, C., Turnbull, P., Hawton, K., Geulayov, G., Waters, K., Ness, J., et al. (2016). Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics. BMJ Open, 6(2), e009749.  https://doi.org/10.1136/bmjopen-2015-009749.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Crain, J., McFaull, S., Thompson, W., Skinner, R., Do, M., Frechette, M., et al. (2016). The Canadian Hospitals Injury Reporting and Prevention Program: a dynamic and innovative injury surveillance system. Health Promotion and Chronic Disease Prevention in Canada Research, Policy and Practice, 36(6). Retrieved from https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/publicat/hpcdp-pspmc/36-6/assets/pdf/ar-02-eng.pdf.CrossRefGoogle Scholar
  9. Crosby, A., Ortega, L., Melanson, C. (2011). Self-directed violence surveillance: uniform definitions and recommended data elements. Atlanta, GA.Google Scholar
  10. Fortune, S., Stewart, A., Yadav, V., & Hawton, K. (2007). Suicide in adolescents: using life charts to understand the suicidal process. J Affect Disord, 100(1–3), 199–210.  https://doi.org/10.1016/j.jad.2006.10.022.CrossRefPubMedGoogle Scholar
  11. Gupta, A., Davison, C., Mcisaac, M. (2016). Health promotion and chronic disease prevention in Canada masking in reports of " most serious " events: bias in estimators of sports injury incidence in Canadian children. Retrieved from http://publications.gc.ca/collections/collection_2016/aspc-phac/HP33-2-36-8-eng.pdf.
  12. Hawton, K., Arensman, E., Townsend, E., Bremner, S., Feldman, E., Goldney, R., Gunnell, D., Hazell, P., van Heeringen, K., House, A., Owens, D., Sakinofsky, I., & Träskman-Bendz, L. (1998). Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ (Clinical Research Ed), 317(7156), 441–447 http://www.ncbi.nlm.nih.gov/pubmed/9703526.CrossRefGoogle Scholar
  13. Hawton, K., Saunders, K., & O’Connor, R. (2012). Self-harm and suicide in adolescents. Lancet, 379(9834), 2373–2382.  https://doi.org/10.1016/S0140-6736(12)60322-5.CrossRefPubMedGoogle Scholar
  14. IBM. (2015). IBM SPSS Statistics for Windows. Armonk, New York: IBM Corp.Google Scholar
  15. Kuramoto-Crawford, S., Spies, E., Davies-Cole, J. (2017). Detecting suicide-related emergency department visits among adults using the District of Columbia Syndromic Surveillance System.  https://doi.org/10.1177/0033354917706933.CrossRefGoogle Scholar
  16. Logue, E., Ali, S., Spiers, J., Newton, A., & Lander, J. (2013). Characteristics of patients and families who make early return visits to the pediatric emergency department. Open Access Emergency Medicine : OAEM, 5, 9–15.  https://doi.org/10.2147/OAEM.S43621.CrossRefPubMedGoogle Scholar
  17. Mackenzie, S., & Pless, I. (1999). CHIRPP: Canada’s principal injury surveillance program. Canadian Hospitals Injury Reporting and Prevention Program. Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention, 5(3), 208–213.  https://doi.org/10.1136/IP.5.3.208.CrossRefGoogle Scholar
  18. Mars, B., Heron, J., Crane, C., Hawton, K., Lewis, G., Macleod, J., et al. (2014). Clinical and social outcomes of adolescent self harm: population based birth cohort study. BMJ, 349. Retrieved from http://www.bmj.com/content/349/bmj.g5954.
  19. Mars, B., Cornish, R., Heron, J., Boyd, A., Crane, C., Hawton, K., Lewis, G., Tilling, K., Macleod, J., & Gunnell, D. (2016). Using data linkage to investigate inconsistent reporting of self-harm and questionnaire non-response. Archives of Suicide Research, 20(2), 113–141.  https://doi.org/10.1080/13811118.2015.1033121.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Martin, J., Cloutier, P. F., Levesque, C., Bureau, J.-F., Lafontaine, M.-F., & Nixon, M. K. (2013). Psychometric properties of the functions and addictive features scales of the Ottawa self-injury inventory: a preliminary investigation using a university aged sample. Psychol Assess, 25(3), 1013–1018.  https://doi.org/10.1037/a0032575.CrossRefPubMedGoogle Scholar
  21. McHugh, M. (2012). Interrater reliability: the kappa statistic. Biochemia Medica, 22(3), 276–282 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23092060.CrossRefGoogle Scholar
  22. Morrison, A., Stone, D., Doraiswamy, N., & Ramsay, L. (1999). Injury surveillance in an accident and emergency department: a year in the life of CHIRPP. Archives of Disease in Childhood, 80(6), 533–536 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10332002.CrossRefGoogle Scholar
  23. Muehlenkamp, J., Claes, L., Havertape, L., & Plener, P. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health, 6(1), 10.  https://doi.org/10.1186/1753-2000-6-10.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Persi, J., Bird, B., & DeRoche, C. (2016). A comparison of voluntary and involuntary child and adolescent inpatient psychiatry admissions. Resid Treat Child Youth, 33(1), 69–83.  https://doi.org/10.1080/0886571X.2016.1167651.CrossRefGoogle Scholar
  25. Randall, J., Roos, L., Lix, L., Katz, L., & Bolton, J. (2017). Emergency department and inpatient coding for self-harm and suicide attempts: validation using clinician assessment data. Int J Methods Psychiatr Res, e1559.  https://doi.org/10.1002/mpr.1559.CrossRefGoogle Scholar
  26. Rhodes, A., Links, P., Streiner, D., Dawe, I., Cass, D., & Janes, S. (2002). Do hospital E-codes consistently capture suicidal behaviour? Chronic Diseases in Canada, 23(4), 139–145 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12517321.PubMedGoogle Scholar
  27. Skegg, K. (2005). Self-harm. Lancet, 366(9495), 1471–1483.  https://doi.org/10.1016/S0140-6736(05)67600-3.CrossRefPubMedGoogle Scholar
  28. Skinner, R., Irvine, B., Willams, G., Pearson, C., Kaur, J., Yao, X., et al. (2017). A contextual analysis of the Suicide Surveillance Indicators The Federal Framework on Suicide Prevention. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 37(8), 257–260.  https://doi.org/10.24095/hpcdp.37.8.05.CrossRefGoogle Scholar
  29. Thomas, K. H., Davies, N., Metcalfe, C., Windmeijer, F., Martin, R. M., & Gunnell, D. (2013). Validation of suicide and self-harm records in the Clinical Practice Research Datalink. Br J Clin Pharmacol, 76(1), 145–157.  https://doi.org/10.1111/bcp.12059.CrossRefPubMedGoogle Scholar
  30. Wilkinson, P., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011). Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Am J Psychiatr, 168(5), 495–501.  https://doi.org/10.1176/appi.ajp.2010.10050718.CrossRefPubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  1. 1.University of OttawaOttawaCanada
  2. 2.Public Health Agency of CanadaOttawaCanada
  3. 3.Children’s Hospital of Eastern Ontario (CHEO)OttawaCanada
  4. 4.CHEO Research InstituteOttawaCanada

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