FROM PEDIATRICS

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

cpnews@frontlinemedcom.com 


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