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. 2015 Dec 29;12(12):e1001931.
doi: 10.1371/journal.pmed.1001931. eCollection 2015 Dec.

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

Annie Herbert  1   2 , Ruth Gilbert  1   2 , Arturo González-Izquierdo  1   2 , Alexandra Pitman  3 , Leah Li  1
Affiliations

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

Annie Herbert et al. PLoS Med. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Formation of adversity-related injury and accident-related injury cohorts among 10–19 y olds.
*49,784 girls and 80,205 boys had more than one emergency admission for injury between 10 and 19 y. For each of these adolescents, one emergency admission for injury was randomly selected as the index emergency admission for injury. **Not possible to impute any missing values at 0–30 y old.
Fig 2
Fig 2. Cumulative risk of death in girls, by age group.
Fig 3
Fig 3. Cumulative risk of death in boys, by age group.
Fig 4
Fig 4. Estimated cumulative risk of death for girls and boys in the general population, by age group.
Fig 5
Fig 5. 10-y risk of death by type of injury.
Fig 6
Fig 6. Cumulative risk of emergency re-admission in girls, by age group.
Fig 7
Fig 7. Cumulative risk of emergency re-admission in boys, by age group.
Fig 8
Fig 8. 10-y risk of emergency re-admission by type of injury.
See this image and copyright information in PMC

Comment in

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