Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011–2017) of One Midwestern City in the US

Abstract

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns emerge that associate with risk for PICU admission. Data were extracted at an urban, high-volume, quaternary care facility from January 2011 to December 2017 via ICD 10 codes associated with suicide. Clinical, socioeconomic, geographical, and temporal variables were reviewed. In total, 1036 patients over the age of 9 were included, of which n = 161 were PICU admissions. Females represented higher proportions of all suicide-related hospital admissions (67.9%). Looking at race/ethnicity, PICU admissions were largely Caucasian (83.2%); Blacks and Hispanics had lower odds of PICU admissions (OR: 0.49; 0.17, respectively). PICU-admitted patients were older (16.0 vs. 15.5; p = 0.0001), with lower basal metabolic index (23.0 vs. 22.0; p = 0.0013), and presented in summer months (OR: 1.51, p = 0.044). Time-series decomposition showed seasonal peaks in June and August. Local regions outside the city limits identified higher numbers of PICU admissions. PICUs serve discrete geographical regions and are a source of information, when paired with clinical geospatial/seasonal analyses, highlighting clinical and societal risk factors associated with PICU admissions.

Suicide and Self-Harm in Children and Adolescents Admitted to PICUs in the United States

“…This is important, since nonfatal self-harm is an independent and significant risk factor for repeated attempts and increased risk of completed suicides (8)(9)(10)(11)(12). In a single-center study of 1,036 patients hospitalized for self-harm, of which 161 were admitted to the PICU (13), patients admitted to the PICU were also predominantly female (64%), were White (83%), and had ingestion as the most common mode of self-harm (66%). As in our study, their observed hospital mortality was low (1.9%), but a greater proportion of patients in that study were discharged home from the PICU (19.3%) compared with ours (7.9%) (13).…”