Discharge disposition of adolescents admitted to medical hospitals after attempting suicide.
OBJECTIVE
To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region.


METHODS
Retrospective cohort analysis.


METHODS
The nationally representative Kids' Inpatient Database for 2000.


METHODS
Patients aged 10 to 19 years with a diagnosis of suicide attempt or self-inflicted injury.Main Outcome Measure Likelihood of transfer to another facility vs discharge to home.


RESULTS
Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children's units in general hospitals (10%), and children's hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children's units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, 0.65-0.97; Midwest: OR, 0.63; 95% CI, 0.49-0.80; West: OR, 0.29; 95% CI, 0.22-0.38).


CONCLUSIONS
Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.
Levine
Leonard J
LJ
Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA 19134, USA. lenlevine@hotmail.com
Schwarz
Donald F
DF
Argon
Jesse
J
Mandell
David S
DS
Feudtner
Chris
C
D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D015897:Comorbidity; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006761:Hospitals / Q000145:classification* / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000145:classification / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States