title: 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.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Population, Policy & Practice Programme, Institute of Child Health, University College London, London, United Kingdom.|Farr Institute of Health Informatics Research, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Annie
authors.initials: A
authors.lastname: Herbert
authors.affiliation: Population, Policy & Practice Programme, Institute of Child Health, University College London, London, United Kingdom.|Farr Institute of Health Informatics Research, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: Gilbert
authors.affiliation: Population, Policy & Practice Programme, Institute of Child Health, University College London, London, United Kingdom.|Farr Institute of Health Informatics Research, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Arturo
authors.initials: A
authors.lastname: González-Izquierdo
authors.affiliation: Division of Psychiatry, University College London, London, United Kingdom.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Pitman
authors.affiliation: Population, Policy & Practice Programme, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Leah
authors.initials: L
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology