BACKGROUND: The emergency department (ED) is a key setting to monitor and detect patients at risk for suicide. Multiple ED syndromic surveillance systems across the United States primarily rely on chief complaints (CC) to monitor and detect health events, because CC provide the timeliest data to detect aberrant patterns. Whether CC alone can accurately detect patients presenting to the ED with suicidal ideation or attempt is unknown; using discharge diagnosis (DD) along with CC might improve surveillance. This study examined use of CC and DD to detect ED visits related to suicide ideation and attempt among adult patients.
METHODS: We analyzed data from the District of Columbia (DC) syndromic-based Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE), which receives ED visit data daily from DC short-term acute care hospitals. We extracted ED visit data for patients aged ≥18 years from 6 nonpediatric DC hospitals that reported CC and DD information to ESSENCE during October 1, 2015–September 30, 2016 (n = 248,939). To identify an ED visit as suicide-related, we searched CC and DD data for suicide-related free text terms or International Classification of Diseases, Ninth Revision, (ICD-9) Clinical Modification or International Classification of Diseases, Tenth Revision (ICD-10), Clinical Modification DD codes only. Descriptive statistics were conducted to examine whether detecting suicide-related visits by using CC, DD, or both varied by patient sex, age, or hospital.
RESULTS: Of the 248,939 ED visits examined, 1,540 (0.6%) were identified as suicide-related on the basis of CC or DD. Of these, 566 visits (37%) had suicide-related terms mentioned in CC but not DD; 384 visits (25%) had suicide-related terms or discharge codes mentioned in both CC and DD. An additional 590 (38%) suicide-related ED visits were detected by using DD only. Whether the suicide-related ED visits were detected through CC, DD, or both did not vary by patient sex or age. However, hospitals differed in whether suicide-related terms were mentioned in CC or DD.
CONCLUSIONS: In the DC ED syndromic surveillance system, 62% of suicide-related ED visits were detected by using CC only or from both CC and DD. By using DD, an additional one-third of suicide-related ED visits were detected. ED syndromic surveillance system using CC alone would underestimate suicide-related ED visits. Detection of suicide-related ED visits by using syndromic surveillance can be improved by incorporating DD into the case definition.