Citation

Rozova V, Witt K, Robinson J, Li Y, Verspoor K. J. Am. Med. Inform. Assoc. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Medical Informatics Association, Publisher Elsevier Publishing)

DOI

10.1093/jamia/ocab261

PMID

34897466

Abstract

OBJECTIVE: Accurate identification of self-harm presentations to Emergency Departments (ED) can lead to more timely mental health support, aid in understanding the burden of suicidal intent in a population, and support impact evaluation of public health initiatives related to suicide prevention. Given lack of manual self-harm reporting in ED, we aim to develop an automated system for the detection of self-harm presentations directly from ED triage notes.

MATERIALS AND METHODS: We frame this as supervised classification using natural language processing (NLP), utilizing a large data set of 477 627 free-text triage notes from ED presentations in 2012-2018 to The Royal Melbourne Hospital, Australia. The data were highly imbalanced, with only 1.4% of triage notes relating to self-harm. We explored various preprocessing techniques, including spelling correction, negation detection, bigram replacement, and clinical concept recognition, and several machine learning methods.

RESULTS: Our results show that machine learning methods dramatically outperform keyword-based methods. We achieved the best results with a calibrated Gradient Boosting model, showing 90% Precision and 90% Recall (PR-AUC 0.87) on blind test data. Prospective validation of the model achieves similar results (88% Precision; 89% Recall).

DISCUSSION: ED notes are noisy texts, and simple token-based models work best. Negation detection and concept recognition did not change the results while bigram replacement significantly impaired model performance.

CONCLUSION: This first NLP-based classifier for self-harm in ED notes has practical value for identifying patients who would benefit from mental health follow-up in ED, and for supporting surveillance of self-harm and suicide prevention efforts in the population.

Language: en

Keywords

emergency department; self-harm; suicidal ideation; machine learning; natural language processing