title: Emergency Department Visits for Self-Inflicted Injuries in Adolescents.
abstract: OBJECTIVE
  To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk.
  
  
  METHODS
  Analyses included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran-Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII.
  
  
  RESULTS
  We examined 286,678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.77), older adolescents (OR 2.73, 95% CI 2.38-3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49-1.80), and Asian adolescents (OR 1.67, 95% CI 1.35-2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70-0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27-1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01-1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78-24.6).
  
  
  CONCLUSIONS
  We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.
authors.affiliation: Departments of Pediatric Emergency Medicine, and gretchen.cutler@childrensmn.org.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Cutler
authors.affiliation: Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrew
authors.initials: A
authors.lastname: Flood
authors.affiliation: Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Jill
authors.initials: J
authors.lastname: Dreyfus
authors.affiliation: Departments of Pediatric Emergency Medicine, and.
authors.forename: Henry W
authors.initials: HW
authors.lastname: Ortega
authors.affiliation: Departments of Pediatric Emergency Medicine, and.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
mesh_terms: D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012652:Self Mutilation / Q000453:epidemiology*; D016728:Self-Injurious Behavior / Q000453:epidemiology*