578 - Emergency Department Utilization by Youth Before and After Self-Inflicted Intentional Injury

Poster Number: 578
Publication Number: 578.1691

Background: There is an urgent need to identify effective suicide prevention strategies to reduce harm and preserve well-being among youth with acute mental health crises.

Objective: To determine emergency department (ED) utilization patterns pre-and post-injury for youth presenting with self-inflicted intentional injury, overall and by ED and youth characteristics.

Design/Methods: We conducted a retrospective, cross-sectional study of ED encounters for self-inflicted intentional injury by children 5-18 years old from April-September 2019 in 8 states using the State Emergency Department and Inpatient Databases (SEDD/SID). We determined whether an ED encounter occurred in the 90 days before or 90 days after an index injury. We summarized encounter characteristics and ED utilization using descriptive statistics. We used multilevel generalized linear models, accounting for hospital clustering, to determine differences in ED utilization, adjusting for ED type (pediatric or non-pediatric) and patient age, sex, race/ethnicity, urbanicity, and insurance status.

Results: We identified 7,234 ED encounters for self-inflicted intentional injury (Table 1). Most youth were adolescents (mean 15.2 years old), female (73%), living in a metropolitan area (80%), and non-Hispanic White (56%). Half were publicly insured (53%). Most injury presentations were to a non-pediatric ED (72%) with few (3%) later transferred to a pediatric ED. In the 90 days before injury, 24% of youth had an ED encounter; of these, 72% occurred in non-pediatric EDs and 40% had a mental or behavioral health diagnosis code (Table 2). In the 90 days after injury, 26% of youth had an ED encounter; of these, 70% occurred in non-pediatric EDs and 46% had a mental or behavioral health diagnosis code. The adjusted odds of having an ED encounter before or after injury was higher among non-Hispanic Black youth (pre-injury aOR 1.42, 95% CI 1.10, 1.84; post-injury aOR 1.42, 95% CI 1.07, 1.88) and publicly insured youth (pre-injury aOR 1.56, 95% CI 1.24, 1.96; post-injury aOR 1.52, 95% CI 1.22, 1.91) and was lower among rural youth (pre-injury aOR 0.48, 95% CI 0.25, 0.95; post-injury aOR 0.58, 95% CI 0.34, 0.98)(Table 3).

Conclusion(s): Youth with self-inflicted intentional injury had high rates of ED utilization before and after injury, particularly for mental and behavioral health complaints. Most received care at non-pediatric EDs. Further work to build interventional capacity in non-pediatric EDs will be required to serve this population.