Outcomes for university students following emergency care presentation for deliberate self-harm: retrospective observational study of Emergency Departments in England for 2017/2018

● Objectives: Identify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm.
● Design: Retrospective cross-sectional observational study.
● Setting: Patients visiting 129 public hospital Emergency Departments across England between April 2017 and March 2018.
● Participants: 14,074 patients aged 18-23 visiting Emergency Departments for conditions linked to deliberate self-harm, 1,016 of which were identified as university-aged students.
● Outcome measures: We study various outcomes across the entire patient pathway in the Emergency Department: Waiting time to initial assessment upon arrival at the emergency department, count of investigations delivered, discharge destination (patients refusing treatment or leave before being seen, referred to another provider or admitted to inpatient care, discharged with no follow-up) and unplanned follow-up visit within 7 days.
● Results: We find a statistically significant difference of 0.262 [-0.491,-0.0327] less investigations delivered to students compared to non-students (about 8 percent compared to the baseline number of investigations for non-students). Stratified analyses reveal that this difference is concentrated amongst students visiting the Emergency Department outside of regular working hours (-0.485 [-0.850,-0.120])and students visiting for repeated deliberate self-harm episodes (-0.881 [-1.510,-0.252]). Unplanned reattendance within 7 days is lower among students visiting Emergency Departments during out of hours (-0.0306 [-0.0576,-0.00363]), whilst students arriving by ambulance are less likely to be referred to another provider (-0.0708 [-0.140,-0.00182]) compared to non-students.
● Conclusions: We find evidence of less intense investigations being delivered to patients aged 18-23 identified as students compared to non-students visiting Emergency Departments after an episode of deliberate self-harm. Given the high risk of suicide attempts after episodes of deliberate self-harm among students, our findings may highlight the need for more focused interventions on this group of patients.