Adolescent self harm patients: audit of assessment in an accident and emergency department.

O’Dwyer, F. G.; Dalton, A. M.; Pearce, J B

doi:10.1136/bmj.303.6803.629

Cited by 27 publications

(14 citation statements)

References 6 publications

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“…19 Another limitation of this study is inherent in the method of reviewing case notes where the information can be inconsistently recorded and vary in quality. 20 The quality of information recorded could be improved if a standardised protocol was available for junior medical staV to assist in their assessment and the authors are currently in the process of preparing a standardised protocol in the A&E department. However, the epidemiology of children presenting to the A&E department with deliberate self harm informs the eVective use of available resources.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm

Nadkarni¹

2000

Emergency Medicine Journal

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Objectives-The aim of this study was to provide a description of the characteristics of children and adolescents presenting to the accident and emergency (A&E) department with deliberate self harm. Method-Descriptive analysis of data collected by reviewing the notes of all children and adolescents aged 16 years and under, presenting during the period of study (1 January to 31 December) with a history of deliberate self harm. Results-A total of 100 children (18 boys, 82 girls) were responsible for 117 episodes of deliberate self harm. Nine repeaters were responsible for 22% of the attendances; 38% had made use of emergency ambulance service and 6% were referred by their general practitioner (GP). Sixty nine per cent were accompanied by immediate family and 21% children presented alone. Seventy four per cent presented within three hours of the attempt and 37% presented between 6 pm and midnight; 77% presented during weekdays and 30% of attempts had occurred during spring. Ninety two per cent had used a pharmaceutical drug. Sixty five per cent had made the attempt at home and 12% in a public place. Twenty five per cent had prior or current contact with the child psychiatric services and a similar proportion had prior or current contact with social services. Conclusions-Few of the children and adolescents presenting with deliberate self harm to the A&E department have been referred by their GP. They frequently present alone or are accompanied by people who are not family members making assessment and treatment diYcult. Many already have other services involved in their care and thus the gathering and dissemination of information can become quite lengthy. The time of presentation is usually out of hours, further complicating this process. A small number of young people present with repeated self harm, who are known to be most vulnerable for completing suicide. (J Accid Emerg Med 2000;17:98-102) Keywords: child and adolescent; deliberate self harm; parasuicide Deliberate self harm is one of the most common causes for presentation to the accident and emergency (A&E) department 1 and children and adolescents under 16 years of age account for around 5% of all episodes referred to hospital because of deliberate self harm. 2This has placed a severe demand on the already stretched resources available to A&E departments across England and Wales. At the same time, these numbers probably represent only the tip of the iceberg and a study examining the possibility of this phenomenon discovered that three out of four cases of deliberate self harm do not lead to contact with services.

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Section: Discussionmentioning

confidence: 99%

Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm

Nadkarni¹

2000

Emergency Medicine Journal

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“…Although patient assessments do not reliably predict the risk of future DSH (Hawton & Fagg, 1995), they can identify patients with treatable mental disorder (House et al, 1998). The Department of Health recommends that every patient have a`specialist psychosocial assessment' before discharge from hospital (Department of Health and Social Security, 1984 (Black & Creed, 1988;O'Dwyer et al, 1991;Ebbage et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Deliberate self-harm

Whyte

Blewett²

2001

Psychiatr. bull.

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Aims and MethodA repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.ResultsAspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.Clinical ImplicationsSetting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.

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“…However, a ratio of 9:1 female to male was reported in a study of those under 16 years presenting to A&E . Elsewhere, a ratio of 3:1 female to male has been reported in a similar population (O'Dwyer et al, 1991).…”

Section: Main Ndingsmentioning

confidence: 94%

“…Particular concerns have been identi ed including the standard of assessment and care provided to younger persons presenting with DSH in English services. There is evidence that younger persons are being discharged from accident and emergency departments (A&E) without a psychiatric assessment despite recommendations to the contrary (O'Dwyer et al, 1991). Changes over time in the management of adults who present with DSH may be an in uencing factor here, as the trend has been for fewer adults to see a psychiatrist (Owens, 1990).…”

Section: Introductionmentioning

confidence: 97%

Self-harm in younger people: audit of prevalence and provision

Clarke¹,

Baker²,

Watts³

et al. 2001

Psychol. Health Med.

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This study investigated the frequency, the response to, and the pathways in care of young persons aged under 16 years (or under 18 years if attending secondary school) presenting to the Accident and Emergency Department (A&E) following deliberate self-harm (DSH). Retrospective case note review was used in two A&E departments and the Social Services Departments, Educational Psychology Services, Child and Family Consultation Services serving two local authority boroughs, a community-based counselling service and participants' general practices. Participants were 60 young people who presented to A&E following DSH over a 12-month period. Participants were identi ed from the department's records. The study group was predominantly female (52/60) and the self-harm mainly involved an overdose (54/60), with paracetamol the most common constituent. One-third of all cases did not receive a specialist assessment, contrary to recommendations, and one-fth were not referred for any specialist follow-up care. There was a low frequency of recording relevant history in A&E, especially, information of previous self-harming behaviour and recent or current problems. A seasonal trend was detected with the rate of presentations falling off during the main school holiday periods. Following evidence that younger persons were being discharged from A&E without adequate assessment or follow-up provision, the service developed improvements in joint working across agencies and designed appropriate protocols for assessment and after-care. The impact of improved service provision is now under investigation in a long-term prospective study, including implementation of a standardized electronic record.

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Adolescent self harm patients: audit of assessment in an accident and emergency department.

Abstract: Objective-To examine the assessment of adolescent self harm patients attending an accident and emergency department.Design-Retrospective assessment of case notes. Setting-Accident and emergency department, Leicester Royal Infirmary.

Cited by 27 publications

References 6 publications

Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm

Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm

Deliberate self-harm

Self-harm in younger people: audit of prevalence and provision

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