Validity of the classification of emergency service requests related to suicidal behavior

Abstract

Introduction. Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective. Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method. A descriptive, cross-sectional study of requests to the ECC of Málaga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results. The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion. The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.

Suicidal behavior in persons attended in out-of-hospital emergency services in Spain

“…Although some articles based on the coding and classification of suicidal behavior cases have been questioned for their lack of reliability and consequently under- or over-recording of cases ( 39 ), in our study, we applied strict criteria to identify the calls as suicidal behavior, since we took into account both the clinical judgment of the out-of-hospital emergency doctor attending the patient in situ and the criteria of the operator responding to the telephone call at the 061 ECC. However, we are aware that a study carried out in our setting concluded that the classification system used in the 061 ECC has a sensitivity of 44.8% for detecting cases of suicidal behavior ( 16 ). Following on from this reflection, Anderson et al ( 40 ) state that little training is available on how visits for suicidal behavior should be documented and that research that relies on international disease classification codes included in medical records to study suicide sometimes significantly underestimates cases of suicide attempts and suicidal ideation.…”

“…Our line of research has focused on studies of suicidal behavioral calls to out-of-hospital emergency services settings only ( 9 , 15 , 16 ). There are also several studies focused on this population in the hospital emergency setting ( 17 – 19 ).…”