Risk of future harm in adolescents admitted to hospitals in England for injury related to victimisation, self-harm, or drug or alcohol misuse: a retrospective cohort study

Abstract

BackgroundInjury related to adversity (ie, maltreatment, violence, self-harm, or drug or alcohol misuse) accounts for most mortality in adolescents. Targeting reduction of future harm in adolescents admitted to hospital with adversity-related injuries is of great public health interest in the UK. Evidence is lacking on the risks of emergency re-admission and death after an adolescent admission for adversity-related injury. We aimed to quantify these risks and to establish whether they are higher than those in adolescents with accident-related injury only. MethodsWe used linked Hospital Episode Statistics and Office for National Statistics mortality data for 10–19-year-old adolescents, who had at least one emergency admission for injury (the index admission; for multiple emergency admissions for injury, we randomly selected one) between April 1, 1997, and March 31, 2012. We conducted time-to-event analyses for emergency re-admission (non-injury or injury for any reason) or death before age 31 years, following the index. FindingsOf 1 080 368 adolescents who had emergency admissions for injury, 335 103 (31·0%) had adversity-related injury at the index admission and 649 774 (60·1%) had accident-related injury. The cumulative incidence of an emergency re-admission 1 year from adversity-related injury was greater than that from an accident-related injury (girls 18·5% [95% CI 18·2–18·7%] vs 8·3 [8·2–8·5], boys 11·2 [11·0–11·3] vs 7·0 [6·9–7·0]), and remained about twice as high 5 and 10 years later. Rates of death within 1 year were greater after adversity-related injury (girls 114/100 000 [99–130] vs 52 [42–64], boys 201 [180–226] vs 56 [49–63]) and was twice to four times as high after 10 years. Relative hazards of re-admissions and death from adversity-related injury for girls and boys were higher than from accident-related injury by 1·65–2·16 times, adjusting for multiple re-admissions, age, chronic conditions, ethnicity, and socioeconomic status. InterpretationThe risk of emergency re-admission or death from an adolescent admission for adversity-related injury is twice as high as that from accident-related injury. Since International Classification of Diseases 10 codes used were moderately sensitive for identifying adversity, the true relative risk could be higher than our estimates. Development of hospital-based interventions in adolescents with adversity-related injury, such as motivational interviewing, which has shown promise for reducing alcohol-related injury in the USA, could reduce this risk. FundingAH was supported by the Policy Research Unit in the Health of Children, Young People and Families, which is funded by the Department of Health Policy Research Programme (grant reference number 109/0001). AH is also supported by the University College London IMPACT studentship. The study funders played no part in the design, data analysis, and interpretation of this study, the writing of the manuscript, or the decision to submit the paper for publication. The authors' work was independent of their funders.