Clinical management of self-harming children and adolescents in the United Kingdom: a multicentre audit

Introduction The risk of self-harm is highest in younger age groups, with increasing numbers of under-18s being admitted to hospital due to self-harm in recent years in the UK1,2. The National Institute for Health and Care Excellence (NICE) guidelines for self-harm in adolescents over eight was updated in September 2022 and reinforces the need for the proper initial management of adolescent self-harm3. To our knowledge, our study is the first UK national audit on the management of self-harm in adolescents presenting to the emergency department using the updated NICE guidelines. Objectives To assess the clinical management of children and adolescents who present to the Emergency Department (ED) following self-harm, a cross-sectional, multicentre study was conducted within teaching hospitals affiliated with nine medical schools across England, Wales and Scotland. Methods Data was retrospectively collected from ED records using consecutive sampling of individuals aged 8 to 17 years who presented with self-harm from 7 Sep-7 Nov 2022. Results Records from 328 patients were included in the final analysis. Most patients were female (82.0%) and white (68.2%), with a mean age of presentation of 14.7 (σ = 1.58). The rate of positive responses to each question is available in Table 1. A ‘positive’ response is defined as a ‘yes’ response, rather than ‘no’ or ‘not documented’. Table 1. Rate of compliance with audit criteria Study Intervention Sample Size Outcome Measure Key Findings Lamy et al. (2020) SGAs (multiple RCTs) >50 trials ABC, CGI Significant reduction in irritability (p<0.05) Ghanizadeh et al. (2014) Aripiprazole, Risperidone 59 ABC Reduction in symptoms; fewer adverse events with aripiprazole King et al. (2009) Citalopram, Placebo 149 CGI, CY-BOCS No significant benefit over placebo; more adverse effects Conclusions This is the first study, to our knowledge, that investigates the management of self-harm in under 18s across the UK using the updated NICE guidelines. Some criteria may have been adhered to but not documented. The results from this study provide support for the further improvement of clinical practice in the management of self-harming children and adolescents. Disclosure of Interest None Declared