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The Manchester Self Harm Rule had good sensitivity but poor specificity for predicting repeat self harm or suicide

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Q In patients who present to the emergency department (ED) with self harm, can a simple clinical rule predict repetitions of self harm or suicide in the next 6 months?


Embedded ImageDesign:

prospective cohort study with separate derivation and validation data sets.

Embedded ImageSetting:

5 EDs in Manchester and Salford, UK.

Embedded ImagePatients:

9086 episodes of self harm (intentional self poisoning or self injury) in patients 11–98 years of age (median 30 y, 56% women). Patients who did not wait for assessment or refused treatment were excluded.

Embedded ImageDescription of prediction guide:

patients were considered to be at moderate or high risk of repeat self harm or suicide if …

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  • For correspondence: Dr J Cooper, Centre for Suicide Prevention, University of Manchester, Manchester, UK. jayne.cooper{at}

  • Sources of funding: Manchester Health Authority, South Manchester University Hospitals NHS Trust, Central Manchester and Manchester Children’s University Hospitals NHS Trust, Pennine Acute NHS Trust, and Mental Health Services of Salford NHS Trust.