Table 3.
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 manual chart abstraction: stratified by Columbia Classification Algorithm of Suicide Assessment categorization (n=600).
| Categorization and classification | True positive, n (%) | False positive, n (%) | False negative, n (%) | True negative, n (%) | Sensitivity (95% CI) | Specificity (95% CI) | Accuracy (95% CI) | |||||||
| Suicidal ideation | ||||||||||||||
|
|
ICD-10-CM: broada | 105 (17.5) | 98 (16.3) | 39 (6.5) | 358 (59.7) | 0.73 (0.66-0.80) | 0.79 (0.75-0.82) | 0.77 (0.74-0.81) | ||||||
|
|
ICD-10-CM: strictb | 104 (17.3) | 87 (14.5) | 40 (6.7) | 369 (61.5) | 0.72 (0.65-0.80) | 0.81 (0.77-0.85) | 0.76 (0.79-0.82) | ||||||
|
|
CCc,d | 73 (12.2) | 58 (9.7) | 71 (11.8) | 398 (66.3) | 0.51 (0.43-0.59) | 0.87 (0.84-0.90) | 0.75 (0.79-0.82) | ||||||
|
|
ICD-10-CM or CCe | 118 (19.7) | 97 (16.2) | 26 (4.3) | 359 (59.8) | 0.82 (0.76-0.88) | 0.79 (0.75-0.82) | 0.80 (0.76-0.83) | ||||||
|
|
ICD-10-CM and CCf | 60 (10) | 49 (8.2) | 84 (14) | 407 (67.8) | 0.42 (0.34-0.50) | 0.89 (0.86-0.92) | 0.78 (0.75-0.81) | ||||||
| Preparatory acts | ||||||||||||||
|
|
ICD-10-CM | 35 (5.8) | 168 (28) | 10 (1.7) | 387 (64.5) | 0.78 (0.66-0.90) | 0.70 (0.66-0.74) | 0.70 (0.67-0.74) | ||||||
|
|
CC | 23 (3.8) | 108 (18) | 22 (3.7) | 447 (74.5) | 0.51 (0.37-0.66) | 0.77 (0.81-0.84) | 0.78 (0.75-0.82) | ||||||
|
|
ICD-10-CM or CC | 36 (6) | 179 (29.8) | 9 (1.5) | 376 (62.7) | 0.80 (0.68-0.92) | 0.64 (0.68-0.72) | 0.69 (0.65-0.72) | ||||||
|
|
ICD-10-CM and CC | 20 (3.3) | 89 (14.8) | 33 (5.5) | 458 (76.3) | 0.38 (0.25-0.51) | 0.81 (0.87-0.84) | 0.80 (0.76-0.83) | ||||||
| Suicide attempt | ||||||||||||||
|
|
ICD-10-CM | 42 (7) | 161 (26.8) | 11 (1.8) | 386 (64.3) | 0.79 (0.68-0.90) | 0.71 (0.67-0.74) | 0.71 (0.68-0.75) | ||||||
|
|
CC | 22 (3.7) | 109 (18.2) | 31 (5.2) | 438 (73) | 0.42 (0.28-0.55) | 0.80 (0.77-0.83) | 0.77 (0.73-0.80) | ||||||
|
|
ICD-10-CM or CC | 44 (7.3) | 181 (30.2) | 9 (1.5) | 366 (61) | 0.83 (0.73-0.93) | 0.67 (0.63-0.71) | 0.67 (0.63-0.71) | ||||||
|
|
ICD-10-CM and CC | 20 (3.3) | 89 (14.8) | 33 (5.5) | 458 (76.3) | 0.38 (0.25-0.51) | 0.84 (0.81-0.87) | 0.80 (0.77-0.83) | ||||||
| Nonsuicidal self-injurious behavior | ||||||||||||||
|
|
ICD-10-CM | 74 (12.3) | 129 (21.5) | 35 (5.8) | 362 (60.3) | 0.68 (0.59-0.77) | 0.74 (0.70-0.78) | 0.73 (0.69-0.76) | ||||||
|
|
CC | 47 (7.8) | 84 (14) | 62 (10.3) | 407 (67.8) | 0.43 (0.34-0.52) | 0.83 (0.80-0.86) | 0.76 (0.72-0.79) | ||||||
|
|
ICD-10-CM or CC | 81 (13.5) | 134 (22.3) | 28 (4.7) | 357 (59.5) | 0.74 (0.66-0.83) | 0.73 (0.69-0.77) | 0.69 (0.73-0.77) | ||||||
|
|
ICD-10-CM and CC | 37 (6.2) | 72 (12) | 71 (11.8) | 420 (70) | 0.34 (0.25-0.43) | 0.82 (0.85-0.88) | 0.73 (0.76-0.80) | ||||||
aThe entire Centers for Disease Control and Prevention case surveillance definition International Classification of Diseases, Tenth Revision, Clinical Modification, code list was used.
bOnly the ICD-10-CM code for suicidal ideation (R45.81) was used.
cCC: chief complaint.
dCC refers to suicide-related chief complaints
dCases 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).
eCases 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).