Repeated presentation of children and adolescents to the emergency department following self-harm: A retrospective audit of hospital data

OBJECTIVE: To examine re-presentation rates for self-harm in patients aged 0-18 years to the ED of a tertiary paediatric hospital in Melbourne, Australia, and associated patient, family and hospital presentation factors. METHODS: Data for presentations from 1 July 2016 to 31 December 2018 were extracted from the hospital's electronic medical record system. Self-harm presentations were identified through automated, rule-based coding and manual review of medical notes. Re-presentation rates for intervals up to 12 months were estimated using survival methods with risk factor associations examined using Cox regression. RESULTS: Of the 952 presentations for self-harm after 1 January 2017, 529 were considered first presentations. An estimated 15% (95% confidence interval [CI] 12-19), 20% (95% CI 17-24) and 23% (95% CI 19-27) re-presented for self-harm within 3, 6 and 12 months, respectively. A total of 82% of all presentations were for girls. Patients were more likely to re-present if they had previously presented more than once, were flagged as vulnerable (hazard ratio [HR] 1.35, 95% CI 1.08-1.68), had a history of substance abuse (HR 1.30, 95% CI 1.03-1.64), were female (HR 1.43, 95% CI 0.92-2.21), had self-cut (HR 1.38, 95% CI 0.96-1.97), had an aggressive behaviour response team called during the visit (HR 1.44, 95% CI 0.85-2.45) or had a history of depression (HR 1.27, 95% CI 0.99-1.63). CONCLUSIONS: In this paediatric ED, almost one in four patients re-presented with self-harm within 12 months. Previous presentations and other factors were associated with risk of re-presenting, although no factor was strongly predictive. Future research might examine the generalisability of these findings across settings and explore strategies for prevention.