Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits
Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention. To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demo...
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| Veröffentlicht in: | JAMA network open 2024-10, Vol.7 (10), p.e2442091 |
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| creator | Edgcomb, Juliet Beni Olde Loohuis, Loes Tseng, Chi-Hong Klomhaus, Alexandra M Choi, Kristen R Ponce, Chrislie G Zima, Bonnie T |
| description | Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.
To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.
This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.
Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.
Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.
The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC |
| doi_str_mv | 10.1001/jamanetworkopen.2024.42091 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11522940</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3143268410</sourcerecordid><originalsourceid>FETCH-LOGICAL-a295t-3a782e74cd0a0b9ea5c8f9f2f5b99b14b1c8eb559c71d6e039a2a402c22733273</originalsourceid><addsrcrecordid>eNpdkVtv1DAQhS0EolXpX0ARvPCSZXxLYl4QKgtFqkRVLm_IcpzJrpfETm0HtP-eLC1V6YNlS3PmzBl_hLygsKIA9PXOjMZj_h3izzChXzFgYiUYKPqIHDNZi5I3IB_fex-R05R2AMCAclXJp-SIK1FDxatj8mM9oM0xeGeLczRD3hZXaEPsisst-pD3k_ObIvTFJXbO5LjIvszOug7LKxxMxq5Yjxg36O2-eI-TiXlEn4vvLrmcnpEnvRkSnt7eJ-Tbh_XXs_Py4vPHT2fvLkrDlMwlN3XDsBa2AwOtQiNt06ue9bJVqqWipbbBVkpla9pVCFwZZgQwy1jN-XJOyNsb32luR-zskiCaQU_RjSbudTBO_1_xbqs34ZemVDKmBCwOr24dYrieMWU9umRxGJbPDnPSnDIqFVRwGPbygXQX5uiX_RaV4KxqBD0YvrlR2RhSitjfpaGgDyT1A5L6QFL_Jbk0P7-_z13rP278D_iyoF8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3143268410</pqid></control><display><type>article</type><title>Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Edgcomb, Juliet Beni ; Olde Loohuis, Loes ; Tseng, Chi-Hong ; Klomhaus, Alexandra M ; Choi, Kristen R ; Ponce, Chrislie G ; Zima, Bonnie T</creator><creatorcontrib>Edgcomb, Juliet Beni ; Olde Loohuis, Loes ; Tseng, Chi-Hong ; Klomhaus, Alexandra M ; Choi, Kristen R ; Ponce, Chrislie G ; Zima, Bonnie T</creatorcontrib><description>Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.
To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.
This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.
Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.
Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.
The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001).
In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2024.42091</identifier><identifier>PMID: 39470636</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Age groups ; California - epidemiology ; Child ; Classification ; Cross-Sectional Studies ; Electronic health records ; Electronic Health Records - statistics & numerical data ; Emergency medical care ; Emergency Room Visits ; Emergency Service, Hospital - statistics & numerical data ; Female ; Health Informatics ; Humans ; Male ; Online Only ; Original Investigation ; Phenotype ; Self-Injurious Behavior - epidemiology ; Suicide - statistics & numerical data ; Suicide prevention ; Suicide, Attempted - statistics & numerical data ; Suicides & suicide attempts</subject><ispartof>JAMA network open, 2024-10, Vol.7 (10), p.e2442091</ispartof><rights>2024. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2024 Edgcomb JB et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a295t-3a782e74cd0a0b9ea5c8f9f2f5b99b14b1c8eb559c71d6e039a2a402c22733273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39470636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Edgcomb, Juliet Beni</creatorcontrib><creatorcontrib>Olde Loohuis, Loes</creatorcontrib><creatorcontrib>Tseng, Chi-Hong</creatorcontrib><creatorcontrib>Klomhaus, Alexandra M</creatorcontrib><creatorcontrib>Choi, Kristen R</creatorcontrib><creatorcontrib>Ponce, Chrislie G</creatorcontrib><creatorcontrib>Zima, Bonnie T</creatorcontrib><title>Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.
To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.
This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.
Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.
Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.
The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001).
In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.</description><subject>Adolescent</subject><subject>Age groups</subject><subject>California - epidemiology</subject><subject>Child</subject><subject>Classification</subject><subject>Cross-Sectional Studies</subject><subject>Electronic health records</subject><subject>Electronic Health Records - statistics & numerical data</subject><subject>Emergency medical care</subject><subject>Emergency Room Visits</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Health Informatics</subject><subject>Humans</subject><subject>Male</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Phenotype</subject><subject>Self-Injurious Behavior - epidemiology</subject><subject>Suicide - statistics & numerical data</subject><subject>Suicide prevention</subject><subject>Suicide, Attempted - statistics & numerical data</subject><subject>Suicides & suicide attempts</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVtv1DAQhS0EolXpX0ARvPCSZXxLYl4QKgtFqkRVLm_IcpzJrpfETm0HtP-eLC1V6YNlS3PmzBl_hLygsKIA9PXOjMZj_h3izzChXzFgYiUYKPqIHDNZi5I3IB_fex-R05R2AMCAclXJp-SIK1FDxatj8mM9oM0xeGeLczRD3hZXaEPsisst-pD3k_ObIvTFJXbO5LjIvszOug7LKxxMxq5Yjxg36O2-eI-TiXlEn4vvLrmcnpEnvRkSnt7eJ-Tbh_XXs_Py4vPHT2fvLkrDlMwlN3XDsBa2AwOtQiNt06ue9bJVqqWipbbBVkpla9pVCFwZZgQwy1jN-XJOyNsb32luR-zskiCaQU_RjSbudTBO_1_xbqs34ZemVDKmBCwOr24dYrieMWU9umRxGJbPDnPSnDIqFVRwGPbygXQX5uiX_RaV4KxqBD0YvrlR2RhSitjfpaGgDyT1A5L6QFL_Jbk0P7-_z13rP278D_iyoF8</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Edgcomb, Juliet Beni</creator><creator>Olde Loohuis, Loes</creator><creator>Tseng, Chi-Hong</creator><creator>Klomhaus, Alexandra M</creator><creator>Choi, Kristen R</creator><creator>Ponce, Chrislie G</creator><creator>Zima, Bonnie T</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20241001</creationdate><title>Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits</title><author>Edgcomb, Juliet Beni ; Olde Loohuis, Loes ; Tseng, Chi-Hong ; Klomhaus, Alexandra M ; Choi, Kristen R ; Ponce, Chrislie G ; Zima, Bonnie T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a295t-3a782e74cd0a0b9ea5c8f9f2f5b99b14b1c8eb559c71d6e039a2a402c22733273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Age groups</topic><topic>California - epidemiology</topic><topic>Child</topic><topic>Classification</topic><topic>Cross-Sectional Studies</topic><topic>Electronic health records</topic><topic>Electronic Health Records - statistics & numerical data</topic><topic>Emergency medical care</topic><topic>Emergency Room Visits</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Health Informatics</topic><topic>Humans</topic><topic>Male</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Phenotype</topic><topic>Self-Injurious Behavior - epidemiology</topic><topic>Suicide - statistics & numerical data</topic><topic>Suicide prevention</topic><topic>Suicide, Attempted - statistics & numerical data</topic><topic>Suicides & suicide attempts</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Edgcomb, Juliet Beni</creatorcontrib><creatorcontrib>Olde Loohuis, Loes</creatorcontrib><creatorcontrib>Tseng, Chi-Hong</creatorcontrib><creatorcontrib>Klomhaus, Alexandra M</creatorcontrib><creatorcontrib>Choi, Kristen R</creatorcontrib><creatorcontrib>Ponce, Chrislie G</creatorcontrib><creatorcontrib>Zima, Bonnie T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Edgcomb, Juliet Beni</au><au>Olde Loohuis, Loes</au><au>Tseng, Chi-Hong</au><au>Klomhaus, Alexandra M</au><au>Choi, Kristen R</au><au>Ponce, Chrislie G</au><au>Zima, Bonnie T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>7</volume><issue>10</issue><spage>e2442091</spage><pages>e2442091-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.
To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.
This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.
Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.
Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.
The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001).
In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>39470636</pmid><doi>10.1001/jamanetworkopen.2024.42091</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Age groups California - epidemiology Child Classification Cross-Sectional Studies Electronic health records Electronic Health Records - statistics & numerical data Emergency medical care Emergency Room Visits Emergency Service, Hospital - statistics & numerical data Female Health Informatics Humans Male Online Only Original Investigation Phenotype Self-Injurious Behavior - epidemiology Suicide - statistics & numerical data Suicide prevention Suicide, Attempted - statistics & numerical data Suicides & suicide attempts |
| title | Electronic Health Record Phenotyping of Pediatric Suicide-Related Emergency Department Visits |
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