Emergency Department Visits for Self-Inflicted Injuries in Adolescents

Cutler, Gretchen J.; Flood, Andrew; Dreyfus, Jill; Ortega, Henry W.; Kharbanda, Anupam B.

doi:10.1542/peds.2014-3573

Cited by 50 publications

(28 citation statements)

References 22 publications

(40 reference statements)

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“…Acute poisoning in children, accidental or voluntary, represents a real problem of public health with an increasing incidence (1,2). Detailed statistical data are provided by the Annual Report of the American Association of Antitoxic Centers, which in 2017 reported 645,000 poisonings in pediatric patients, of which 27% (171,303 cases) in the age group 13-18 years.…”

Section: Discussionmentioning

confidence: 99%

Psychological disturbances in adolescents with acute voluntary poisoning

Nitescu¹,

Boghiţoiu²,

Ulmeanu³

2019

Ro J Pediatr.

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Objective. The present study has two main objectives: to evaluate the psychological characteristics of adolescents with voluntary acute poisoning in a pediatric toxicology department and to estimate the role of psychological evaluation in the management of these patients. Material and method. The study includes the retrospective analysis of all patients with voluntary acute intoxication, admitted to our clinic between October 1, 2017 and September 30, 2018. The following criteria were considered: age, gender, number of hospitalizations with this diagnosis and psychological evaluation. performed during hospitalization. Results. During the mentioned period, in the Toxicology and Intensive Care Department of the Emergency Clinical Hospital for Children "Grigore Alexandrescu" in Bucharest, 181 patients were admitted with the diagnosis of voluntary acute poisoning, aged between 10 and 18 years. There was a similar percentage of girls compared to boys (58.1% compared to 41.9%), and most patients (n = 137, 75.7%) were from urban areas. Of the total number of patients 22 (12.1%) had two or more hospitalizations with the diagnosis of voluntary acute intoxication. In 13 cases (7.2%), patients were known to have previous psychiatric disorders: 8 patients with depression, 2 with behavioral disorder and 3 with disorders associated with chronic substance abuse. Analyzing the results of the psychological evaluation in these patients we found that the main psychological disorder was the emotional reaction, being identified in 98 patients (54.1%). The suicide attempt was identified in only 31 patients (17.1%) of whom only 10 received the transfer recommendation in a psychiatric clinic. Conclusions. Psychological evaluation of patients with acute voluntary intoxication is essential during hospitalization in the toxicology section to identify real psychological problems. Emotional reaction is the main psychological disorder in patients with acute voluntary intoxication. The actual suicide attempt is found only in a relatively small number of patients, in our study being diagnosed only at 17% of the total voluntary acute poisoning.

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Section: Discussionmentioning

confidence: 99%

Psychological disturbances in adolescents with acute voluntary poisoning

Nitescu¹,

Boghiţoiu²,

Ulmeanu³

2019

Ro J Pediatr.

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“…In Ontario during 2002 to 2011, incident rates decreased between 2002/03 to 2006/07, but not thereafter, for adolescents aged 12 to 17 years [ 38 ]. In the United States, rates per 1,000 increased from 2.57 to 4.53 during 1993 to 2008 for adolescents aged 15–19 [ 39 ] while for those aged 10 to 18 years a National Trauma Data Bank study showed ED visits for self-harm increased from 2009 to 2012 [ 40 ]. Our nine-year Canadian population-based study showed the overall rate of ED visits by sex declined during the study period.…”

Section: Discussionmentioning

confidence: 99%

Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada

et al. 2016

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BackgroundClustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit.MethodsWe extracted a population-based cohort of adolescents aged 15–17 years (n = 3,927) with ED visits during 2002–2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan.ResultsThe rates decreased over time for ED visits for self-harm (differences: girls −199.6/100,000; p < 0.01; boys −58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls −108.3/100,000; p < 0.01; boys −61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002–2006 (p < 0.01) and (2) a South zone cluster during 2003–2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01).ConclusionsThe rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

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“…Concerning the evaluation and management of children and adolescents with acute mental health problems (comprising SITBs and suicide ideation and/or attempts), three main issues are currently debated in literature: first, children and adolescents in psychiatric crisis are seen in general pediatric or medical EDs, which are crowded, noisy, high-stimulation environments, often with long waiting times and not enough private or quiet space; [ 6 ] second, most young people presenting with a psychiatric crisis are treated by pediatric emergency clinicians and staff who lack psychiatric training, or by adult psychiatric clinicians who lack training in the diagnosis and treatment of children and adolescents; [ 5 , 6 , 14 , 15 ] third, more than half of the youths presenting to the ED after a suicide attempt or another episode of deliberate self-harm do not receive a mental health assessment. [ 16 , 17 ]…”

Section: Introductionmentioning

confidence: 99%

Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors

et al. 2017

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The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.

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Emergency Department Visits for Self-Inflicted Injuries in Adolescents

Cited by 50 publications

References 22 publications

Psychological disturbances in adolescents with acute voluntary poisoning

Psychological disturbances in adolescents with acute voluntary poisoning

Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada

Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors

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