Adolescents discharged from hospitals in England after an admission for violent, drug- or alcohol-related, or self-inflicted injuries have increased risks of subsequent death and emergency re-admission up to a decade later, according to a study published this week in PLOS Medicine. The study, conducted by Annie Herbert at University College London, UK, and colleagues, showed that in England, risks of death after all types of adversity-related injury were higher than after accident-related injury (61% (95% CI 43%-82%) higher in girls and 113% (95% CI 98%-129%) higher in boys).
Adolescents who present with an adversity-related injury often re-present later with other adversity-related injuries. However, national guidance in England stipulates psychosocial assessment only for presentations of self-inflicted injury. To determine which adolescents in the broader group are at elevated risk of further harm, Herbert and colleagues used National Health Service hospital admissions data from 1997 into 2012 for 10-19 year olds with emergency admissions for adversity-related or accident-related injury (333,009 and 649,818 adolescents, respectively). Among adolescents discharged after adversity-related injury, one in 137 girls and one in 64 boys died within ten years, and 54.2% of girls and 40.5% of boys had a subsequent emergency re-admission. These rates were roughly 1.5-2 times higher than after accident-related injury. Risks of death were highest in 18-19 year olds (one in 52 boys and one in 90 girls), and those with either chronic conditions (typically mental/behavioural or respiratory disorders for adolescents in this study) or who lived in deprived areas.
Misclassification of some adversity-related injuries as accident-related injuries, and residual confounding by unknown characteristics shared within the two groups, may affect the accuracy of these findings. Nevertheless, these findings identify a broader range of risk factors for subsequent harm. The authors state, "[t]hese findings justify extending national policy for psychosocial assessment after self-inflicted injury to all types of adversity-related injury."
This study was funded by the Policy Research Unit in the Health of Children, Young People and Families (funding reference 109/00017), which is funded by the Department of Health Policy Research Programme. This is an independent report commissioned and funded by the Department of Health. The views expressed are not necessarily those of the Department. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors have declared that no competing interests exist.
Herbert A, Gilbert R, González-Izquierdo A, Pitman A, Li L (2015) 10-y Risks of Death and Emergency Re-admission in Adolescents Hospitalised with Violent, Drug- or Alcohol-Related, or Self-Inflicted Injury: A Population-Based Cohort Study. PLoS Med 12(12): e1001931. doi:10.1371/journal.pmed.1001931
Population, Policy & Practice Programme, Institute of Child Health, University College London, London, United Kingdom Farr Institute of Health Informatics Research, Department of Epidemiology and Public Health, University College London, London, United Kingdom Division of Psychiatry, University College London, London, United Kingdom
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