Readmissions after Pediatric Hospitalization for Suicide Ideation and Suicide Attempt
OBJECTIVE: To inform resource allocation toward a continuum of care for youth at risk of suicide, we examined unplanned 30-day readmissions after pediatric hospitalization for either suicide ideation (SI) or suicide attempt (SA).
METHODS: We conducted a retrospective cohort study of a nationally representative sample of 133,516 hospitalizations for SI or SA among 6- to 17-year-olds to determine prevalence, risk factors, and characteristics of 30-day readmissions using the 2013 and 2014 Nationwide Readmissions Dataset (NRD). Risk factors for readmission were modeled using logistic regression.
RESULTS: We identified 95,354 hospitalizations for SI and 38,162 hospitalizations for SA. Readmission rates within 30 days were 8.5% for SI and SA hospitalizations. Among 30-day readmissions, more than one-third (34.1%) occurred within 7 days. Among patients with any 30-day readmission, 11% had more than one readmission within 30 days. The strongest risk factors for readmission were SI or SA hospitalization in the 30 days preceding the index SI/SA hospitalization (adjusted odds ratio [AOR]: 3.14, 95% CI: 2.73-3.61) and hospitalization for other indications in the previous 30 days (AOR: 3.18, 95% CI: 2.67-3.78). Among readmissions, 94.5% were for a psychiatric condition and 63.4% had a diagnosis of SI or SA.
CONCLUSIONS: Quality improvement interventions to reduce unplanned 30-day readmissions among children hospitalized for SI or SA should focus on children with a recent prior hospitalization and should be targeted to the first week following hospital discharge.
© 2018 Society of Hospital Medicine
Suicide is a leading cause of death among 10- to 34-year-olds in the United States.1,2 During the past two decades, the youth suicide death rate has risen by 24%, and more than 5,000 young people die from suicide each year.3 Suicide ideation (SI) and suicide attempts (SAs) are well-established risk factors for suicide death and a source of morbidity for patients and families. One-third of youth with SI attempt suicide at some point in their lifetime.4 Approximately 11% of youth SAs result in suicide death, and 2% of youth who attempt suicide subsequently go on to die from suicide after recovering from a prior SA.5 More than 60,000 youth are hospitalized for SI or SA each year,6 and young people hospitalized for SA are at high short-term risk of repeat SA and suicide death.7 Hospitals need strategies for measuring the quality of SI and SA hospitalizations, monitoring postdischarge outcomes, and identifying the patients at the highest risk of poor outcomes. Readmissions are a useful hospital quality measure that can indicate re-emergence of SI, repeat SA, or inadequate community-based mental health treatment, and interventions designed for patients with readmissions can potentially avert morbidity or mortality.
