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Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national
Kristine Sørensen1, Morten Breinholt Søvsø1,2, Charlotte Nørkjær Eggertsen3
1Centre for Prehospital and Emergency Research at Danish Center for Health Services Research, Aalborg University Hospital, Gistrup, Denmark.
Insights
Emergency clinicians must recognize non-accidental or intentional self-harm injuries in children to prevent harm. This study found that only a small fraction of diagnosed pediatric injuries were initially reported via emergency medical services (EMS) calls.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Child Injury Prevention
Background:
- Early recognition of non-accidental or intentional self-harm injuries in children by emergency clinicians is critical for preventing morbidity.
- Understanding the incidence and mechanisms of these injuries is vital for targeted interventions.
Purpose of the Study:
- To determine the probability of suspected non-accidental or intentional self-harm injuries in children following an emergency call.
- To investigate injury mechanisms and the involvement of legal/social authorities by emergency medical services (EMS).
Main Methods:
- A nationwide population-based cohort study in Denmark (2016-2023).
- Included children ≤15 years with suspected non-accidental or intentional self-harm diagnoses after an emergency call.
- Data sourced from national hospital registers and prehospital patient records; probability stratified by sex.
Main Results:
- The incidence of suspected non-accidental or intentional self-harm injuries was 34 per 100,000 children annually.
- 0.52% of pediatric emergency medical services calls resulted in such a diagnosis, with 'Assault' (31.2%) and 'Intentional self-harm' (28.7%) being common categories.
- Children aged 12-15 had a higher probability; mortality was 1.4%. Police involvement by EMS was 17.6%, social authorities 2.0%.
Conclusions:
- A small proportion of children diagnosed with suspected non-accidental or intentional self-harm injuries were initially transported by emergency medical services.
- Two-thirds of injuries were inflicted by others, one-third by self-harm.
- Emergency medical services' involvement with legal or social authorities was infrequent.
Background:
Recognition of a non-accidental or intentional self-harm injury by emergency clinicians is essential to help prevent further physical and mental morbidity.The study objectives were to calculate the probability of paediatric suspected non-accidental or intentional self-harm injuries after an emergency call and to investigate the mechanisms of injury and any involvement of legal or social authorities noted by emergency medical services (EMS).
Methods:
Nationwide population-based cohort study in Denmark from 1 January 2016 to 31 December 2023, including children ≤15 years for whom an emergency call had been made and who received a diagnosis of a suspected non-accidental or intentional self-harm injury by a hospital physician. Data were obtained from national hospital registers and from prehospital patient medical records. Injury probability after an emergency call was calculated stratified by sex.
Results:
In hospital registers, the incidence of suspected non-accidental or intentional self-harm injuries was 34 per 100 000 children per year and among 138 599 paediatric EMS calls, 0.52% (95% CI 0.48% to 0.56%) resulted in such a diagnosis. Subgroups were 'Asphyxiation' (2.5%), 'Maltreatment' (15.1%), 'Assault' (31.2%), 'Sexual abuse' (5.9%), 'Intentional self-harm' (28.7%) and '>1 of the above categories' (16.6%). Children aged 12-15 years had a higher probability of these injuries, both in males and females. In a sensitivity analysis excluding 'Assault' and 'Intentional self-harm', the probability increased markedly for males <1 year. All-cause mortality was 1.4% (n=10, 95% CI 0.7% to 2.6%). EMS had involved police in 17.6% and social authorities in 2.0%.
Conclusion:
Of all the children diagnosed with a suspected non-accidental or intentional self-harm injury in a hospital in Denmark, only a small proportion had been brought to the hospital by the EMS. Two-thirds of the injuries had been inflicted by another person, while a third was due to intentional self-harm. Involvement of legal or social authorities by EMS was uncommon.
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