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Leonard J. Levine, MD; Donald F. Schwarz, MD, MPH; Jesse Argon; David S. Mandell, ScD; Chris Feudtner, MD, PhD, MPH

Arch Pediatr Adolesc Med. 2005;159:860-866.

Objective  To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region.

Design  Retrospective cohort analysis.

Setting  The nationally representative Kids’ Inpatient Database for 2000.

Participants  Patients aged 10 to 19 years with a diagnosis of suicide attempt or self-inflicted injury.

Main Outcome Measure  Likelihood of transfer to another facility vs discharge to home.

Results  Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children’s units in general hospitals (10%), and children’s hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children’s units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, 0.65-0.97; Midwest: OR, 0.63; 95% CI, 0.49-0.80; West: OR, 0.29; 95% CI, 0.22-0.38).

Conclusions  Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.

Author Affiliations: Craig-Dalsimer Division of Adolescent Medicine (Drs Levine and Schwarz) and Pediatric Generalist Research Group, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine (Drs Mandell and Feudtner and Mr Argon), and Department of Psychiatry (Dr Mandell), The Leonard Davis Institute of Health Economics (Drs Mandell and Feudtner) and Center of Bioethics (Dr Feudtner), University of Pennsylvania, Philadelphia. Dr Levine is now with the Division of Adolescent Medicine, St Christopher’s Hospital for Children, Philadelphia.

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