Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.
Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
BMJ Open. 2024 Feb 6;14(2):e078672. doi: 10.1136/bmjopen-2023-078672.
Identify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm.
Retrospective cross-sectional observational study.
Patients visiting 129 public hospital emergency departments across England between April 2017 and March 2018.
14 074 patients aged 18-23 visiting emergency departments for conditions linked to deliberate self-harm, 1016 of which were identified as university-aged students.
We study various outcomes across the entire patient pathway in the emergency department: waiting time to initial assessment on arrival at the emergency department, count of investigations delivered, discharge destination (patients refusing treatment or leave before being seen, referred to another provider or admitted to inpatient care, discharged with no follow-up) and unplanned follow-up visit within 7 days.
We find a statistically significant difference of 0.262 (-0.491 to -0.0327) less investigations delivered to students compared with non-students (about 8% compared with the baseline number of investigations for non-students). Stratified analyses reveal that this difference is concentrated among students visiting the emergency department outside of regular working hours (-0.485 (-0.850 to -0.120)) and students visiting for repeated deliberate self-harm episodes (-0.881 (-1.510 to -0.252)). Unplanned reattendance within 7 days is lower among students visiting emergency departments during out of hours (-0.0306 (-0.0576 to -0.00363)), while students arriving by ambulance are less likely to be referred to another provider (-0.0708 (-0.140 to -0.00182)) compared with non-students.
We find evidence of less-intense investigations being delivered to patients aged 18-23 identified as students compared with non-students visiting emergency departments after an episode of deliberate self-harm. Given the high risk of suicide attempts after episodes of deliberate self-harm among students, our findings may highlight the need for more focused interventions on this group of patients.
确定大学生身份，并将其与在同一年龄组因故意自伤就诊于急诊部的其他患者进行对比，了解他们的医疗服务提供情况和结局。
回顾性横断面观察性研究。
2017 年 4 月至 2018 年 3 月期间，英格兰 129 家公立医院急诊部就诊的 18-23 岁患者。
14074 名因故意自伤相关疾病就诊于急诊部的患者，其中 1016 名被确定为大学生。
我们研究了急诊部整个患者就诊路径中的各种结局：到达急诊部后首次评估的等待时间、检查次数、出院去向（拒绝治疗或在就诊前离开、转至其他提供者或收治入院、无随访出院）和 7 天内的非计划性随访就诊。
我们发现，与非学生相比，学生接受的检查数量明显减少（0.262 次，-0.491 至 -0.0327，约减少 8%）。分层分析显示，这种差异主要集中在非工作时间就诊的学生（-0.485 次，-0.850 至 -0.120）和因重复故意自伤就诊的学生（-0.881 次，-1.510 至 -0.252）中。非工作时间就诊的学生 7 天内非计划性再次就诊的比例较低（-0.0306 次，-0.0576 至 -0.00363），而乘坐救护车就诊的学生与非学生相比，被转至其他提供者的可能性较低（-0.0708 次，-0.140 至 -0.00182）。
与因故意自伤就诊的非学生相比，我们发现被认定为学生的 18-23 岁患者接受的检查较少。鉴于学生在故意自伤发作后自杀未遂的风险较高，我们的研究结果可能强调需要对这群患者进行更有针对性的干预。
