Background
Hospitalisation
for adversity-related injury (violent, drug/alcohol-related, or self-inflicted
injury) has been described as a “teachable moment”, when intervention may
reduce risks of further harm. Which adolescents are likely to benefit most from
intervention strongly depends on their long-term risks of harm. We compared
10-y risks of mortality and re-admission after adversity-related injury with
risks after accident-related injury.
Methods and Findings
We
analysed National Health Service admissions data for England (1 April 1997–31
March 2012) for 10–19 y olds with emergency admissions for adversity-related
injury (violent, drug/alcohol-related, or self-inflicted injury; n = 333,009) or for accident-related injury (n = 649,818). We used Kaplan–Meier estimates
and Cox regression to estimate and compare 10-y post-discharge risks of death
and emergency re-admission. Among adolescents discharged after
adversity-related injury, one in 137 girls and one in 64 boys died within 10 y,
and 54.2% of girls and 40.5% of boys had an emergency re-admission, with rates
being highest for 18–19 y olds. Risks of death were higher than in adolescents
discharged after accident-related injury (girls: age-adjusted hazard ratio
1.61, 95% CI 1.43–1.82; boys: 2.13, 95% CI 1.98–2.29), as were risks of
re-admission (girls: 1.76, 95% CI 1.74–1.79; boys: 1.41, 95% CI 1.39–1.43).
Risks of death and re-admission were increased after all combinations of
violent, drug/alcohol-related, and self-inflicted injury, but particularly
after any drug/alcohol-related or self-inflicted injury (i.e., with/without
violent injury), for which age-adjusted hazard ratios for death in boys ranged
from 1.67 to 5.35, compared with 1.25 following violent injury alone (girls:
1.09 to 3.25, compared with 1.27). The main limitation of the study was
under-recording of adversity-related injuries and misclassification of these
cases as accident-related injuries. This misclassification would attenuate the
relative risks of death and re-admission for adversity-related compared with
accident-related injury.
Conclusions
Adolescents discharged after an admission for violent,
drug/alcohol-related, or self-inflicted injury have increased risks of
subsequent harm up to a decade later. Introduction of preventive strategies for
reducing subsequent harm after admission should be considered for all types of
adversity-related injury, particularly for older adolescents.
Below: Cumulative risk of death in girls, by age group
Below: Cumulative risk of death in girls, by age group
By:
Annie Herbert, Ruth Gilbert, Arturo González-Izquierdo, Leah
Li
Population, Policy &
Practice Programme, Institute of Child Health, University College London,
London, United Kingdom
Annie Herbert, Ruth Gilbert, Arturo González-Izquierdo
Farr Institute of Health
Informatics Research, Department of Epidemiology and Public Health, University
College London, London, United Kingdom
Alexandra Pitman
Division of Psychiatry,
University College London, London, United Kingdom
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