Which Youth with Alcohol and Drug-Related Injuries Are At Highest Risk For Future Death And Emergency Readmission?

Serious injury in adolescents may offer an opportunity to intervene and prevent future injury and death. However, it is unknown which injured adolescents are at greatest risk for future adverse health outcomes. Researchers used UK National Health Service data to identify adolescents (age 10–19 years), hospitalized for injury between 1997 and 2012: 333,009 for “adversity-related” (violent, drug or alcohol-related, or self-inflicted) injury and 649,818 hospitalized for “accident-related” injury. They then compared rates of death and emergency readmission by gender, age, and injury group within 10 years of the index hospitalization.

• Drugs and/or alcohol caused the majority of adversity-related injuries (90% in girls; 57% in boys).
• Compared with accident-related injury, adversity-related injury was associated with an increased risk of death in girls (hazard ratio [HR], 1.61) and boys (HR, 2.13) within 10 years.
• Compared with accident-related injury, adversity-related injury was associated with increased risk of emergency readmission in girls (HR, 1.76) and boys (HR, 1.41) within 10 years.
• In both boys and girls, risk for death and emergency readmission increased with older age at the index injury hospitalization and was highest after drug/alcohol-related or self-inflicted injury.

Comments:

This large study indicates an increased 10-year risk for death and emergency readmission among older youth and those admitted for injury from violence, alcohol, drugs, or self-infliction. Although there may have been some residual confounding in this secondary analysis, the results certainly have face validity. The challenge will be the development and implementation of effective interventions to prevent future harm.

Kevin L. Kraemer, MD, MSc

Reference:

Herbert A, Gilbert R, González-Izquierdo A, et al. 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. PLOS Med. 2015;12(12):e1001931.