Do hospital E-codes consistently capture suicidal behaviour?

Area of Science:

• Public Health
• Epidemiology
• Mental Health Research

Background:

• Hospital separation data, using external cause of injury (E-codes), are frequently used for suicide research.
• The accuracy of E-codes in reflecting actual suicidal behaviors, particularly deliberate self-poisoning, remains under-examined.
• Understanding data limitations is crucial for reliable research and effective public health planning.

Purpose of the Study:

• To assess the consistency between hospital separation E-code data and clinical assessments of suicidal behavior.
• To determine the validity of E-codes for researching suicidal behavior, focusing on self-poisoning incidents.

Main Methods:

• Expert clinicians reviewed medical records of individuals hospitalized for self-poisoning.
• Clinicians determined the deliberateness of self-poisoning.
• Latent class analysis estimated the prevalence of deliberate self-poisoning.
• This estimate was compared against E-code-based prevalence.

Main Results:

• Clinician assessment indicated a 63% higher prevalence of deliberate self-poisoning compared to E-code data.
• Discrepancies were significantly larger in older age groups, patients receiving primarily medical care, and those with longer hospital stays.
• Self-poisoning in the elderly within acute care settings may be under-recognized and under-documented.

Conclusions:

• Hospital separation data, relying on E-codes, provide a questionable estimate of suicidal behavior prevalence.
• Findings highlight significant underestimation, particularly among vulnerable populations like the elderly.
• Recommendations for improved data collection and clinical documentation are implied for accurate surveillance.