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ER visits predict premature death among teenagers
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
2012 (Engelska)Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 48, nr S1, s. 397-400Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures. Methods: In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hospital in Umea. Sweden, during 1993 through 2006 because of injury were checked against the National Cause of Death Register in Sweden. Standardised mortality ratio and confidence intervals were calculated. For the unnatural deaths that took place in Sweden, the police report, autopsy protocol, and hospital records, if present, were studied. Results: Thirty-eight fatalities were included giving a standardised mortality ratio of 1.44 (95% CI: 1.02-1.98). A majority of the decedents were males (n = 32, 84%) and the median age at the time of death was 21 years. Twenty-three deaths were caused by unintentional injuries and ten by intentional injuries (all suicides), while five deaths were categorised as undetermined whether intentional or not. Seventy-four percent tested positive for either alcohol or drugs or a combination at the post mortem examination. Nine males and one female committed suicide, five tested positive for alcohol (one also for drugs), while four tested negative at the post mortem examination. One died abroad and in this case we lack information on alcohol and drugs. Conclusion: Teenagers visiting an emergency room due to injury experience an increased risk of premature death by unnatural cause and those at risk are especially males. The use of alcohol and drugs often seems to contribute to their untimely deaths. Identifying those at risk when they visit the emergency room for an injury and to take preventive actions at this stage could be a way to reduce the number of fatalities. (C) 2012 Elsevier Ltd. All rights reserved.

Ort, förlag, år, upplaga, sidor
Oxford: Elsevier, 2012. Vol. 48, nr S1, s. 397-400
Nyckelord [en]
ER, Premature death, Alcohol/drugs
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-60058DOI: 10.1016/j.aap.2012.02.012ISI: 000307140500045OAI: oai:DiVA.org:umu-60058DiVA, id: diva2:559440
Tillgänglig från: 2012-10-09 Skapad: 2012-10-01 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Teenager fatalities: epidemiology and implications for prevention
Öppna denna publikation i ny flik eller fönster >>Teenager fatalities: epidemiology and implications for prevention
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide.

The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures.

A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy.

In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide.

Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved.

Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation.

The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention.

This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet, 2010. s. 56
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1371
Nyckelord
Teenager, fatalities, injury, suicide, alcohol, drugs, intoxication, trends
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-36682 (URN)978-91-7459-063-0 (ISBN)
Disputation
2010-10-29, Betula, by 6M, Umeå, 15:05 (Svenska)
Opponent
Handledare
Tillgänglig från: 2010-10-11 Skapad: 2010-10-07 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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Johansson, LarsStenlund, HansEriksson, Anders

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Accident Analysis and Prevention
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi

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