Mnatzaganian George, Giallo Rebecca, Martin Reagan, Crombie Angela, Nehme Ziad, Delardes Belinda, Burns David, Furness Susan, Lenten Tim, Sharples Renee, Hanson Lisa, Huxley Rachel
La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia.
Front Psychiatry. 2025 Apr 30;16:1573824. doi: 10.3389/fpsyt.2025.1573824. eCollection 2025.
This population-based study explored the Australian Refined Diagnosis Related Groups (AR-DRG) complexity of self-harm admissions over time at a major regional hospital in Victoria, Australia. It also assessed the prehospital paramedic management of such admitted patients.
Self-harm admissions at the hospital from January 1, 2010, to December 31, 2020, were included, excluding accidental injuries and children under 10. Hospital records were linked with Ambulance Victoria electronic patient care records. Trends in the age- and social status-adjusted AR-DRG complexity of self-harm hospitalisations by sex were analysed using Dickey-Fuller and MacKinnon tests. Odds of presenting with a major complexity were modelled using the Generalised Estimating Equations approach.
Overall, 2,000 individuals (58.6% female, mean age at last admission 36.9 ± 18.6 years), contributing to 2,808 admissions, were included in the study. The proportion of self-harm admissions with a major AR-DRG complexity significantly increased over time, from 9.3% in 2010 to 43.5% in 2020 (p<0.001). Both increased complexity and intensive care unit admissions were observed in both males and females. The use of multiple self-harm methods also rose over time. Of the 2,000 patients, 1,416 (70.8%) sought emergency services assistance within 30 days of hospital admission, with 139 (9.8%) not transported to the emergency department. These non-transported patients had higher odds of presenting to the hospital within one month of the prehospital paramedic assessment with more complex conditions (odds ratio 2.04, 95% confidence interval 1.39-2.99, p<0.001) and longer hospital stays compared to those who were transported.
Our findings indicate a trend toward more severe cases of self-harm over time, observed in both males and females, with an increase in the use of multiple self-harm methods. Additionally, our results suggest that paramedic non-transports to the emergency department should be re-evaluated, as these patients experience worse outcomes.
这项基于人群的研究探讨了澳大利亚维多利亚州一家主要地区医院自伤入院患者随时间推移的澳大利亚细化诊断相关分组（AR-DRG）复杂性。它还评估了此类入院患者的院前护理人员管理情况。
纳入2010年1月1日至2020年12月31日期间该医院的自伤入院患者，排除意外伤害和10岁以下儿童。医院记录与维多利亚州救护车电子患者护理记录相关联。使用迪基-富勒检验和麦金农检验分析按性别调整年龄和社会地位后的自伤住院患者AR-DRG复杂性趋势。使用广义估计方程法对出现严重复杂性情况的几率进行建模。
总体而言，2000名个体（58.6%为女性，末次入院时平均年龄36.9±18.6岁），共2808次入院，纳入了该研究。自伤入院且具有严重AR-DRG复杂性的比例随时间显著增加，从2010年的9.3%增至2020年的43.5%（p<0.001）。男性和女性均出现复杂性增加和重症监护病房入院情况增多。多种自伤方法的使用也随时间增加。在2000名患者中，1416名（70.8%）在入院后30天内寻求紧急服务协助，其中139名（9.8%）未被送往急诊科。与被送往医院的患者相比，这些未被运送的患者在院前护理人员评估后一个月内出现更复杂病情并住院时间更长的几率更高（优势比2.04，95%置信区间1.39 - 2.99，p<0.001）。
我们的研究结果表明，随着时间推移，男性和女性自伤病例均呈现出病情更严重的趋势，多种自伤方法的使用有所增加。此外，我们的结果表明，应重新评估护理人员未将患者送往急诊科的情况，因为这些患者的预后较差。
