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Self-harm, Assault, and Undetermined Intent Injuries Among Pediatric Emergency Department Visits

Ballard, Elizabeth D. PhD*; Kalb, Luther G. MHS; Vasa, Roma A. MD*‡; Goldstein, Mitchell MD†§; Wilcox, Holly C. PhD*†

doi: 10.1097/PEC.0000000000000627
Original Articles

Objectives Although injuries are a known cause of morbidity and mortality among children and adolescents, little is known about the epidemiology of injury-related emergency department (ED) visits in the United States by injury intent. The objective of this analysis was to examine ED outcomes, defined as death in the ED, inpatient admission, and visit cost, among ED visits stratified by injury intent (ie, self-harm, assault, and injury with undetermined intent, as compared with unintentional injuries).

Methods All injury-related ED visits in the United States for children and adolescents, ages 8 to 17 years, were identified using the 2008 Nationwide Emergency Department Sample. Multivariate survey weighted logistic and linear regression analyses were then used to estimate the likelihood of death on ED visit, inpatient admission, and cost across the 4 injury types.

Results In 2008, with the use of weighted estimates, there were 66,895 self-harm, 176,125 assault, 24,144 undetermined injury, and 4,244,589 unintentional injury ED visits among children 8 to 17 years. Visits due to self-harm, assault and undetermined injuries were more likely to result in death during the ED visit compared with visits due to unintentional injuries. Self-harm and undetermined intent were also associated with greater odds of inpatient admission as well as 90% and 60% higher ED visit costs, respectively.

Conclusions Data from this nationwide sample of pediatric ED visits highlight the resource burden of self-harm, undetermined intent, and assault injury visits. Pediatric EDs may provide a window of opportunity for better case identification and intervention with children experiencing violence and injury.

From the *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine; †Department of Mental Health, Johns Hopkins Bloomberg School of Public Health; ‡Center for Autism and Related Disorders, Kennedy Krieger Institute; §Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Disclosure: The authors declare no conflict of interest.

Reprints: Elizabeth D. Ballard, PhD, Building 10, CRC Room 7–5541, 10 Center Dr, Bethesda, MD 20892 (e-mail:

All phases of this study were supported by a NIH grant R21MH090480 to Holly C. Wilcox.

Dr Ballard is now with the Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD.

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