Self-inflicted Injuries and Adolescents: Are Specialized Resources Needed in Adult Trauma Centers? Open Access
Soelling, Stefanie (Spring 2020)
Background: Suicide is the second leading cause of adolescent death suicide attempts outnumber deaths 50:1 for adolescents 15 to 19 years of age. This study examines differences in outcomes between adolescents and adults treated at an adult trauma center in an effort to guide recovery and prevention strategies following adolescent suicide attempt.
Methods: The data were obtained from a retrospective review of charts for patients aged >14 years treated at an urban, Level 1 trauma center for self-inflicted injuries between January 1, 2009 and October 31, 2018. The cohort was divided into two age groups: adolescents (14-19 years) and adults (>20 years) and two economic distress groups: group A (distressed) and group B (non-distressed). Demographic characteristics, injury mechanism and clinical outcomes were compared between groups. Geospatial analysis was also performed.
Results: Among 723 patients, 60 (8%) were adolescents of which 92% were male, 55% black, and 45% white/other. In the adult group, 76% were male, 41% black, and 59% white/other. Twenty-eight adolescents (47%) sustained blunt injuries and 32 (53%) penetrating injuries compared to 188 (28.4%) adult blunt injuries and 475 (72%) penetrating injuries. Adolescent median injury severity score (ISS) was 16 (interquartile range [IQR]: 4.5-25), adult median ISS was 10 (IQR: 4-25). Mortality estimates for adolescents and adults were 35% and 24%, respectively (p=0.09). Most adolescent deaths occurred within 3 days after admission while adult deaths occurred further into hospitalization (p<0.01). Psychiatric care was administered in 64% of adolescents (n=39) and 84% of adults (p< 0.01). Both groups A and B had a cumulative mortality of 25% (p=0.4). Spatial analysis identified overlapping clusters of high SITI standardized incidence ratios and high DCI scores.
Conclusions: Psychiatric resources for adolescent patients who present after self-inflicted injury to an adult trauma center were found to be deficient. As a result, this population received significantly less inpatient psychiatric care compared to adults with similar rates of mortality. The high incidence of suicide attempts and subsequent mortality in adolescents requires immediate attention and more resources to addess this public health crisis.
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|Self-inflicted Injuries and Adolescents: Are Specialized Resources Needed in Adult Trauma Centers? ()||2020-03-27 18:41:35 -0400||