2 Risk factors for suicide-related revisits at US Pediatric Emergency Departments

Objectives/Goals: Nearly 1 in 5 children with a suicide-related emergency department (ED) visit will have a suicide attempt within 18 months. Our objective was to determine demographic and clinical characteristics associated with time to ED revisit with self-injurious thoughts and behaviors (SITB) within 6 months. Methods/Study Population: We performed a retrospective cohort study of children aged 6 to 17 years with a primary mental health ED visit at 38 US children’s hospitals from January 2021 to December 2023. Data were obtained from the Pediatric Health Information System administrative database. We included the first index mental health ED visit for each child. Primary outcome was time to first ED revisit with a SITB diagnosis within 6 months of a patient’s index mental health ED visit, defined by ICD-10-CM diagnosis codes. We evaluated demographic and clinical characteristics associated with time to SITB revisit using a multivariable Cox Proportional Hazards Regression model. Results/Anticipated Results: We included 201,214 unique children, 8.7% had an ED revisit with SITB within 6 months. Among children with an SITB revisit, 74.6% had SITB diagnosed at the index visit. Multiple demographic characteristics were associated with longer time to revisit including male sex (HR 0.76, 95% CI 0.74-0.79) compared to female, private insurance (HR 0.83, 95% CI 0.80-0.86) compared to public, and Hispanic race and ethnicity (HR 0.81, 95% CI 0.77-0.85) compared to non-Hispanic White. Clinical characteristics associated with a shorter time to SITB revisit included index visit diagnoses for intentional self-harm (HR 1.32, 95% CI 1.27-1.38), suicidal ideation (Hazard Ratio (HR) 1.65, 95% CI 1.59-1.71), and mood disorder (HR 1.38, 95% CI 1.33-1.44). Discussion/Significance of Impact: Three in four children with a SITB ED revisit had SITB diagnosed at the index visit. Children with index visit suicidal ideation were at highest risk of SITB revisit. These findings highlight missed opportunities to identify and address pediatric SITB at the index ED visit and to prevent ED revisits.