1. Emergency department visits for self-inflicted injury among adolescents during 2009-2012 were examined using a national trauma database. The number of emergency department visits for self-inflicted injury significantly increased over this time period.
2. There was a significant decrease in the proportion of adolescents who sustained a firearm-related self-inflicted injury, and cutting/piercing was the most common form of self-harm. In line with previous trends, males were more likely to use firearms for to inflict self-harm while females were more likely to cut/pierce.
Evidence Rating Level: 1 (Excellent)
Study Rundown: One of the leading causes of death among adolescents is suicide, making self-harm a major public health concern. In order to aid in suicide prevention, the healthcare community must have access to the most recent information on this topic. This study used the National Trauma Data bank to analyze the most recent trends in adolescent self-inflicted injury (SII) behavior. Researchers found that the overall rate of self-harm behavior is increasing over time. However, the proportion of SII using firearms has decreased significantly over the study period. Males were found to be more likely to use firearms, and females were more likely to cut/pierce. Odds of SII were higher among females, older, Asian adolescents, those using public or self pay insurance, and lower among African American adolescents. Those most likely to die from their SIIs were males, older teens, whites, and self-payers. Overall, teens coming to the emergency department (ED) for SII had a significantly higher risk of death compared to those coming for other causes of trauma. While this study presents the most recent information on the trends in SII, it is limited by the selectivity of the database. Specifically, other methods of SII such as poisoning are not well-documented, as they are not considered traumatic. In addition, intent was not addressed within this database, and therefore prevented more specific analysis.
Study Author, Dr. Gretchen J. Cutler, PhD, MPH, talks to 2 Minute Medicine: Center for Acute Care Outcomes, Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
“This article is an important read for medical students/residents/and fellows because it provides the most recent data on trends in self-inflicted injury (SII) behavior for adolescents visiting emergency departments/trauma centers across the United States. These findings provide potential targets for SII prevention efforts in the emergency department or other healthcare settings.”
In-Depth [retrospective cohort study]: This study included all adolescent trauma patients, ages 10 to 18 years, from 2009 through 2012 using the National Trauma Data Bank (NTB). The NTB is the largest collection of trauma cases, and includes > 95% of level 1 and 2 trauma centers nationally. Of the 286 678 adolescent patients, 3664 (1.3%) sustained SII. Visits for SII increased significantly from 1.1% in 2009 to 1.6% in 2012 (p < .001). SII using firearms decreased from 27.3% in 2009 to 21.9% in 2012 (p = .02). Cut/pierce was the most common mechanism of injury, especially among females, comprising 48% of SII among females, while firearm SII was the most common method among males (34.4%). When stratified by demographics, odds of SII were higher in females (OR 1.41, 95% CI 1.13-1.77), older adolescents ages 15 to 18 years (OR 2.73 95% CI 2.38-3.14), Asians (OR 1.67, 95% CI 1.35-2.08), and those using self-pay or public insurance (OR 1.44, 95% CI 1.27-1.64). African American teens had lower odds of SII (OR 0.78, 95% CI 0.70-0.87). Overall, adolescents coming to the ED with SII had higher odds of death than visits for other traumatic injuries (OR 12.9, 95% CI 6.78-24.6).
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