Emergency Department Visits for Self-Inflicted Injuries in Adolescents

Abstract

OBJECTIVES: To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk. METHODS: Analyses included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran–Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII. RESULTS: We examined 286 678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13–1.77), older adolescents (OR 2.73, 95% CI 2.38–3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49–1.80), and Asian adolescents (OR 1.67, 95% CI 1.35–2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70–0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27–1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01–1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78–24.6). CONCLUSIONS: We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.