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PLoS Med. 2015 Dec 29;12(12):e1001931. doi: 10.1371/journal.pmed.1001931. eCollection 2015 Dec.

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.

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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.
Division of Psychiatry, University College London, London, United Kingdom.



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.


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.


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.

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