Multi-site medical record review for validation of intentional self-harm coding in emergency departments

Barbara A. Gabella, Beth Hume, Linda Li, Marianne Mabida, Julia Costich

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Codes in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), are used for injury surveillance, including surveillance of intentional self-harm, as they appear in administrative billing records. This study estimated the positive predictive value of ICD-10-CM codes for intentional self-harm in emergency department (ED) billing records for patients aged 10 years and older who did not die and were not admitted to an inpatient medical service. Methods: The study team in Maryland, Colorado, and Massachusetts selected all or a random sample of ED billing records with an ICD-10-CM code for intentional self-harm (specific codes that began with X71-X83, T36-T65, T71, T14.91). Positive predictive value (PPV) was determined by the number and percentage of records with a physician diagnosis of intentional self-harm, based on a retrospective review of the original medical record. Results: The estimated PPV for the codes’ capture of intentional self-harm based on physician diagnosis in the original medical record was 89.8% (95% CI 85.0–93.4) for Maryland records, 91.9% (95% CI 87.7–95.0) for Colorado records, and 97.3% (95% CI 95.1–98.7) for Massachusetts records. Conclusion: Given the high PPV of the codes, epidemiologists can use the codes for public health surveillance of intentional self-harm treated in the ED using ICD-10-CM coded administrative billing records. However, these codes and related variables in the billing database cannot definitively distinguish between suicidal and non-suicidal intentional self-harm.

Original languageEnglish
Article number16
JournalInjury Epidemiology
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
The authors thank the following colleagues: Pedro Martinez, MPH, and Ellen Yard, PhD, for methodological guidance and feedback on the data collection manual; Sharon Emmerling for development of the data collection manual and collection of Colorado data; Christine Demont, MPH for the analysis of the Colorado sampling frame (Table 2), and Matthew Tumpney, ScM, from the Massachusetts Department of Public Health for feedback on the manuscript. The authors also thank the reviewers from Medical Record Associates, LLC, for their expertise, guidance, feedback, and collection of Massachusetts data and the project team at the University of Maryland School of Medicine National Study Center for Trauma and Emergency Medical Systems for their feedback, collection, and analysis of the Maryland data.

Funding Information:
This study was funded by the Centers for Disease Control and Prevention, award numbers 6NU17CE924841, 6NU17CE924846, 6NU17CE924835, 5NU17CE924831. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention in the United States Department of Health and Human Services, the State of Colorado, the Colorado Hospital Association, the State of Kentucky, the State of Maryland, or the State of Massachusetts.

Publisher Copyright:
© 2022, The Author(s).


  • ICD-10-CM
  • Intentional self-harm
  • Population surveillance
  • Suicide

ASJC Scopus subject areas

  • Medicine (all)


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