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自杀查的风险模型引导临床决策支持:一项随机临床试验

Colin G Walsh^1,2,3, Michael A Ripperger¹, Laurie Novak¹

¹Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.

JAMA network open

|January 3, 2025

概括

与非中断性CDS相比,中断性临床决策支持 (CDS) 显著增加了自杀风险评估. 这一发现突显了针对性警报在自杀预防策略中的潜力.

科学领域:

临床信息学临床信息学
精神病学是一个精神病学.
公共卫生公共卫生

背景情况:

有效的自杀预防需要强大的风险识别,干预和后续协议.
目前的风险识别方法,包括自我报告和临床查,都有局限性.
统计风险模型具有潜力,但在临床工作流程中面临整合挑战,特别是关于警报负担和临床决策支持 (CDS) 的有效性.

研究的目的:

评估风险模型驱动的临床决策支持 (CDS) 在促使自杀风险评估方面的有效性.
为了比较自杀风险评估的中断性与非中断性CDS警报系统.

主要方法:

一个比较有效性的随机临床试验,涉及561名患者在一个学术医疗中心的神经病学部门.
患者被随机分配到中断或非中断的CDS系统,该系统旨在通过实时验证的统计自杀企图风险模型进行进一步的自杀风险评估.
自杀风险评估文档被手动审查,以确定主要结果 (决定亲自评估风险) 和次要结果 (自杀意念和尝试率).

主要成果:

与非中断性CDS (4%) 和前一年的基线率 (8%) 相比,中断性CDS导致查自杀风险的决定显著增加 (42%).
决定用中断性CDS与非中断性CDS进行查的几率比率为17.70 (95% CI,6.42-48.79;P <.001).
在研究期间,在任何治疗臂中都没有观察到有记录的自杀念头或自杀企图.

结论:

断断续续的临床决策支持 (CDS) 显著增加了记录自杀风险评估的速度.
这些发现支持使用中断性CDS来促使个人进行自杀风险评估.
建议进行进一步的大规模试验,将中断性CDS与标准护理进行比较,以评估其在减少自杀性自伤方面的有效性.

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