Table 2.
Performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), code (as defined by the Centers for Disease Control and Prevention case surveillance definition list) and suicide-related chief complaint in detecting cases of self-injurious thoughts and behaviors compared with that of manual chart abstraction: total sample and stratified by natal sex, age group, race, and ethnicity.
| Sample and classification | True positive, n (%) | False positive, n (%) | False negative, n (%) | True negative, n (%) | Sensitivity (95% CI) | Specificity (95% CI) | Accuracy (95% CI) | |||||||||
| All (n=600) | ||||||||||||||||
|
|
ICD-10-CM | 199 (33.2) | 4 (0.7) | 85 (14.2) | 312 (52) | 0.70 (0.65-0.75) | 0.99 (0.98-1.00) | 0.85 (0.82-0.88) | ||||||||
|
|
CCa,b | 129 (21.5) | 2 (0.3) | 155 (25.8) | 314 (52.3) | 0.45 (0.40-0.51) | 0.99 (0.98-1.00) | 0.74 (0.70-0.77) | ||||||||
|
|
ICD-10-CM or CCc | 220 (36.7) | 5 (0.8) | 64 (10.7) | 311 (51.8) | 0.77 (0.73-0.82) | 0.98 (0.97-1.00) | 0.89 (0.86-0.91) | ||||||||
|
|
ICD-10-CM and CCd | 108 (18) | 1 (0.2) | 176 (29.3) | 315 (52.5) | 0.38 (0.32-0.44) | 1.00 (0.99-1.00) | 0.71 (0.67-0.74) | ||||||||
| Sex | ||||||||||||||||
|
|
Male (n=276) | |||||||||||||||
|
|
|
ICD-10-CM | 78 (28.3) | 0 (0) | 45 (16.3) | 153 (55.4) | 0.63 (0.55-0.72) | 1.00 (1.00-1.00) | 0.84 (0.79-0.88) | |||||||
|
|
|
CC | 52 (18.8) | 0 (0) | 71 (25.7) | 153 (55.4) | 0.42 (0.34-0.51) | 1.00 (1.00-1.00) | 0.74 (0.69-0.79) | |||||||
|
|
|
ICD-10-CM or CC | 85 (30.8) | 0 (0) | 38 (13.8) | 153 (55.4) | 0.69 (0.61-0.77) | 1.00 (1.00-1.00) | 0.86 (0.82-0.90) | |||||||
|
|
|
ICD-10-CM and CC | 45 (16.3) | 0 (0) | 78 (28.3) | 153 (55.4) | 0.37 (0.28-0.45) | 1.00 (1.00-1.00) | 0.72 (0.66-0.77) | |||||||
|
|
Female (n=324) | |||||||||||||||
|
|
|
ICD-10-CM | 121 (37.3) | 4 (1.2) | 40 (12.3) | 159 (49.1) | 0.75 (0.68-0.82) | 0.98 (0.95-1.00) | 0.86 (0.83-0.90) | |||||||
|
|
|
CC | 77 (23.8) | 2 (0.6) | 84 (25.9) | 161 (49.7) | 0.48 (0.40-0.56) | 0.99 (0.97-1.00) | 0.73 (0.69-0.78) | |||||||
|
|
|
ICD-10-CM or CC | 135 (41.7) | 5 (1.5) | 26 (8) | 158 (48.8) | 0.84 (0.78-0.90) | 0.97 (0.94-1.00) | 0.90 (0.87-0.94) | |||||||
|
|
|
ICD-10-CM and CC | 63 (19.4) | 1 (0.3) | 98 (30.2) | 162 (50) | 0.39 (0.32-0.47) | 0.99 (0.98-1.00) | 0.69 (0.64-0.74) | |||||||
| Age group (years) | ||||||||||||||||
|
|
10-12.9 (n=115) | |||||||||||||||
|
|
|
ICD-10-CM | 33 (28.7) | 0 (0) | 26 (22.6) | 56 (48.7) | 0.56 (0.43-0.69) | 1.00 (1.00-1.00) | 0.77 (0.70-0.85) | |||||||
|
|
|
CC | 25 (21.7) | 0 (0) | 34 (29.6) | 56 (48.7) | 0.42 (0.30-0.55) | 1.00 (1.00-1.00) | 0.70 (0.62-0.79) | |||||||
|
|
|
ICD-10-CM or CC | 39 (33.9) | 0 (0) | 20 (17.4) | 56 (48.7) | 0.66 (0.54-0.78) | 1.00 (1.00-1.00) | 0.83 (0.76-0.90) | |||||||
|
|
|
ICD-10-CM and CC | 19 (16.5) | 0 (0) | 40 (34.8) | 56 (48.7) | 0.32 (0.20-0.44) | 1.00 (1.00-1.00) | 0.65 (0.57-0.74) | |||||||
|
|
13-15.9 (n=215) | |||||||||||||||
|
|
|
ICD-10-CM | 90 (41.9) | 1 (0.5) | 26 (12.1) | 98 (45.6) | 0.78 (0.70-0.85) | 0.99 (0.97-1.00) | 0.87 (0.83-0.92) | |||||||
|
|
|
CC | 57 (26.5) | 1 (0.5) | 59 (27.4) | 98 (45.6) | 0.49 (0.40-0.58) | 0.99 (0.97-1.00) | 0.72 (0.66-0.78) | |||||||
|
|
|
ICD-10-CM or CC | 100 (46.5) | 2 (0.9) | 16 (7.4) | 97 (45.1) | 0.86 (0.80-0.92) | 0.98 (0.95-1.00) | 0.92 (0.88-0.95) | |||||||
|
|
|
ICD-10-CM and CC | 47 (21.9) | 0 (0) | 69 (32.1) | 99 (46) | 0.41 (0.32-0.49) | 1.00 (1.00-1.00) | 0.68 (0.62-0.74) | |||||||
|
|
16-17.9 (n=270) | |||||||||||||||
|
|
|
ICD-10-CM | 76 (28.1) | 3 (1.11) | 33 (1.5) | 158 (58.5) | 0.70 (0.61-0.78) | 0.98 (0.96-1.00) | 0.87 (0.83-0.91) | |||||||
|
|
|
CC | 47 (17.4) | 1 (0.4) | 62 (23) | 160 (59.3) | 0.43 (0.34-0.52) | 0.99 (0.98-1.00) | 0.77 (0.72-0.82) | |||||||
|
|
|
ICD-10-CM or CC | 81 (30) | 3 (1.11) | 28 (10.4) | 158 (58.5) | 0.74 (0.66-0.83) | 0.98 (0.96-1.00) | 0.89 (0.85-0.92) | |||||||
|
|
|
ICD and CC | 42 (15.6) | 1 (0.4) | 67 (24.8) | 160 (59.3) | 0.39 (0.29-0.48) | 0.99 (0.98-1.00) | 0.75 (0.70-0.80) | |||||||
| Race and ethnicity | ||||||||||||||||
|
|
Asian, non-Hispanic (n=35) | |||||||||||||||
|
|
|
ICD-10-CM | 12 (34.3) | 0 (0) | 3 (8.6) | 20 (57.1) | 0.8 (0.6-1.00) | 1.00 (1.00-1.00) | 0.82 (0.91-1.00) | |||||||
|
|
|
CC | 5 (14.3) | 0 (0) | 10 (28.6) | 20 (57.1) | 0.33 (0.09-0.57) | 1.00 (1.00-1.00) | 0.56 (0.71-0.86) | |||||||
|
|
|
ICD-10-CM or CC | 13 (37.1) | 0 (0) | 2 (5.7) | 20 (57.1) | 0.87 (0.69-1.00) | 1.00 (1.00-1.00) | 0.87 (0.94-1.00) | |||||||
|
|
|
ICD-10-CM and CC | 4 (11.4) | 0 (0) | 11 (31.4) | 20 (57.1) | 0.27 (0.04-0.49) | 1.00 (1.00-1.00) | 0.69 (0.53-0.84) | |||||||
|
|
Black, non-Hispanic (n=61) | |||||||||||||||
|
|
|
ICD-10-CM | 21 (34.4) | 0 (0) | 10 (16.4) | 30 (49.2) | 0.68 (0.51-0.84) | 1.00 (1.00-1.00) | 0.84 (0.74-0.93) | |||||||
|
|
|
CC | 12 (19.7) | 0 (0) | 19 (31.1) | 30 (49.2) | 0.39 (0.22-0.56) | 1.00 (1.00-1.00) | 0.57 (0.69-0.80) | |||||||
|
|
|
ICD-10-CM or CC | 23 (37.7) | 0 (0) | 8 (13.1) | 30 (49.2) | 0.74 (0.59-0.90) | 1.00 (1.00-1.00) | 0.78 (0.87-0.95) | |||||||
|
|
|
ICD-10-CM and CC | 10 (16.4) | 0 (0) | 21 (34.4) | 30 (49.2) | 0.32 (0.16-0.49) | 1.00 (1.00-1.00) | 0.66 (0.54-0.77) | |||||||
|
|
Hispanic or Latinx (n=161) | |||||||||||||||
|
|
|
ICD-10-CM | 44 (27.3) | 1 (0.6) | 25 (15.5) | 91 (56.5) | 0.64 (0.52-0.75) | 0.99 (0.97-1.00) | 0.84 (0.78-0.90) | |||||||
|
|
|
CC | 32 (19.9) | 1 (0.6) | 37 (23) | 91 (56.5) | 0.46 (0.35-0.58) | 0.99 (0.97-1.00) | 0.76 (0.70-0.83) | |||||||
|
|
|
ICD-10-CM or CC | 51 (31.7) | 2 (1.2) | 18 (11.2) | 90 (55.9) | 0.74 (0.64-0.84) | 0.98 (0.95-1.00) | 0.82 (0.88-0.93) | |||||||
|
|
|
ICD-10-CM and CC | 25 (15.5) | 0 (0) | 44 (27.3) | 92 (57.1) | 0.36 (0.25-0.48) | 1.00 (1.00-1.00) | 0.66 (0.73-0.80) | |||||||
|
|
White, non-Hispanic (n=285) | |||||||||||||||
|
|
|
ICD-10-CM | 106 (37.2) | 2 (0.7) | 42 (14.7) | 135 (47.4) | 0.72 (0.64-0.79) | 0.99 (0.97-1.00) | 0.85 (0.80-0.89) | |||||||
|
|
|
CC | 68 (23.9) | 1 (0.4) | 80 (28.1) | 136 (47.7) | 0.46 (0.38-0.54) | 0.99 (0.98-1.00) | 0.72 (0.66-0.77) | |||||||
|
|
|
ICD-10-CM or CC | 116 (40.7) | 2 (0.7) | 32 (11.2) | 135 (47.4) | 0.78 (0.72-0.85) | 0.99 (0.97-1.00) | 0.88 (0.84-0.92) | |||||||
|
|
|
ICD-10-CM and CC | 58 (20.4) | 1 (0.4) | 90 (31.6) | 136 (47.7) | 0.39 (0.31-0.47) | 0.99 (0.98-1.00) | 0.68 (0.63-0.73) | |||||||
|
|
Othere (n=58) | |||||||||||||||
|
|
|
ICD-10-CM | 16 (27.6) | 1 (1.7) | 5 (8.6) | 36 (62.1) | 0.76 (0.58-0.94) | 0.97 (0.92-1.03) | 0.82 (0.90-0.97) | |||||||
|
|
|
CC | 12 (20.7) | 0 (0) | 9 (15.5) | 37 (63.8) | 0.57 (0.36-0.78) | 1.00 (1.00-1.00) | 0.75 (0.84-0.94) | |||||||
|
|
|
ICD-10-CM or CC | 17 (29.3) | 1 (1.7) | 4 (6.9) | 36 (62.1) | 0.81 (0.64-0.98) | 0.97 (0.92-1.03) | 0.84 (0.91-0.99) | |||||||
|
|
|
ICD-10-CM and CC | 11 (19) | 0 (0) | 10 (17.2) | 37 (63.8) | 0.52 (0.31-0.74) | 1.00 (1.00-1.00) | 0.73 (0.83-0.92) | |||||||
aCC: chief complaint.
bCC refers to suicide-related chief complaints.
cCases classified as self-injurious thoughts and behaviors if either a suicide-related ICD-10-CM code or a suicide-related CC was present (either affirmed).
dCases classified as self-injurious thoughts and behaviors if both a suicide-related ICD-10-CM code and a suicide-related CC were present (both affirmed).
eAmerican Indian or Alaska Native, Native Hawaiian or Pacific Islander, multiple races, not available, other, patient refused, and unknown.