10-y Risks of Death and Emergency Re-admission in Adolescents Hospitalised with Violent,Drug- or Alcohol-Related,or Self-Inflicted Injury: A Population-Based Cohort Study

Background: hospitalisation for adversity-related injury (violent,drug/alcohol-related,or self-inflicted injury) has been described as a “teachable moment”,when intervention may reduce risks of further harm. which adolescents are likely to benefit most from intervention strongly depends on their long-term risks of harm. we compared 10-y risks of mortality and re-admission after adversity-related injury with risks after accident-related injury. methods and findings: we analysed national health service admissions data for england (1 april 1997–31 march 2012) for 10–19 y olds with emergency admissions for adversity-related injury (violent,drug/alcohol-related,or self-inflicted injury; n = 333,009) or for accident-related injury (n = 649,818). we used kaplan–meier estimates and cox regression to estimate and compare 10-y post-discharge risks of death and emergency re-admission. among adolescents discharged after adversity-related injury,one in 137 girls and one in 64 boys died within 10 y,and 54.2% of girls and 40.5% of boys had an emergency re-admission,with rates being highest for 18–19 y olds. risks of death were higher than in adolescents discharged after accident-related injury (girls: age-adjusted hazard ratio 1.61,95% ci 1.43–1.82; boys: 2.13,95% ci 1.98–2.29),as were risks of re-admission (girls: 1.76,95% ci 1.74–1.79; boys: 1.41,95% ci 1.39–1.43). risks of death and re-admission were increased after all combinations of violent,drug/alcohol-related,and self-inflicted injury,but particularly after any drug/alcohol-related or self-inflicted injury (i.e.,with/without violent injury),for which age-adjusted hazard ratios for death in boys ranged from 1.67 to 5.35,compared with 1.25 following violent injury alone (girls: 1.09 to 3.25,compared with 1.27). the main limitation of the study was under-recording of adversity-related injuries and misclassification of these cases as accident-related injuries. this misclassification would attenuate the relative risks of death and re-admission for adversity-related compared with accident-related injury. conclusions: adolescents discharged after an admission for violent,drug/alcohol-related,or self-inflicted injury have increased risks of subsequent harm up to a decade later. introduction of preventive strategies for reducing subsequent harm after admission should be considered for all types of adversity-related injury,particularly for older adolescents. © 2015 herbert et al.