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Related Experiment Video

Updated: Jun 20, 2026

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Published on: December 6, 2024

Identifying deliberate self-harm in emergency department data.

Jennifer Bethell¹, Anne E Rhodes

¹Suicide Studies Unit, St. Michael's Hospital, Toronto, Ontario, M5B 1W8. BethellJ@smh.toronto.ca

|September 5, 2009

Summary

Emergency department data may undercount deliberate self-harm (DSH) cases. Some "undetermined" (UD) records likely represent DSH, potentially increasing incidence estimates by up to 60%.

Related Experiment Videos

Last Updated: Jun 20, 2026

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Published on: December 6, 2024

Area of Science:

Public Health
Epidemiology
Emergency Medicine

Background:

Emergency department (ED) data provide more representative deliberate self-harm (DSH) insights than inpatient data.
ED data may underestimate DSH if "undetermined" (UD) codes represent self-harm incidents.

Purpose of the Study:

To investigate the proportion of "undetermined" (UD) coded emergency department (ED) presentations that represent deliberate self-harm (DSH).
To assess the impact of including UD codes in DSH incidence estimates.

Main Methods:

Analysis of 24,437 Ontario ED records from 2001/2002 coded as DSH or UD.
Comparison of age- and sex-specific estimates under alternative DSH definitions.

Main Results:

One in three ED presentations were coded as UD for every two coded as DSH.
UD presentations involving cut/pierce injuries and poisonings were more likely to represent DSH.
Including UD cases increased 12-month DSH cumulative incidence by up to 60%.

Conclusions:

A significant proportion of ED presentations coded as "undetermined" likely represent deliberate self-harm.
Revising coding practices for UD cases is crucial for accurate DSH surveillance.