Use of emergency department electronic medical records for automated epidemiological surveillance of suicide attempts: a French pilot study

The aim of this study was to determine whether an expert system based on automated processing of electronic health records (EHRs) could provide a more accurate estimate of the annual rate of emergency department (ED) visits for suicide attempts in France, as compared to the current national surveillance system based on manual coding by emergency practitioners. A feasibility study was conducted at Lyon University Hospital, using data for all ED patient visits in 2012. After automatic data extraction and pre-processing, including automatic coding of medical free-text through use of the Unified Medical Language System, seven different machine-learning methods were used to classify the reasons for ED visits into suicide attempts versus other reasons. The performance of these different methods was compared by using the F-measure. In a test sample of 444 patients admitted to the ED in 2012 (98 suicide attempts, 48 cases of suicidal ideation, and 292 controls with no recorded non-fatal suicidal behaviour), the F-measure for automatic detection of suicide attempts ranged from 70.4% to 95.3%. The random forest and naive Bayes methods performed best. This study demonstrates that machine-learning methods can improve the quality of epidemiological indicators as compared to current national surveillance of suicide attempts.