Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark.
BMJ paediatrics open · 2026-06-09 · Registry study
Abstract
BACKGROUND: Recognition of a non-accidental or intentional self-harm injury by emergency clinicians is essential to help prevent further physical and mental morbidity.The study objectives were to calculate the probability of paediatric suspected non-accidental or intentional self-harm injuries after an emergency call and to investigate the mechanisms of injury and any involvement of legal or social authorities noted by emergency medical services (EMS). METHODS: Nationwide population-based cohort study in Denmark from 1 January 2016 to 31 December 2023, including children ≤15 years for whom an emergency call had been made and who received a diagnosis of a suspected non-accidental or intentional self-harm injury by a hospital physician. Data were obtained from national hospital registers and from prehospital patient medical records. Injury probability after an emergency call was calculated stratified by sex. RESULTS: In hospital registers, the incidence of suspected non-accidental or intentional self-harm injuries was 34 per 100 000 children per year and among 138 599 paediatric EMS calls, 0.52% (95% CI 0.48% to 0.56%) resulted in such a diagnosis. Subgroups were 'Asphyxiation' (2.5%), 'Maltreatment' (15.1%), 'Assault' (31.2%), 'Sexual abuse' (5.9%), 'Intentional self-harm' (28.7%) and '>1 of the above categories' (16.6%). Children aged 12-15 years had a higher probability of these injuries, both in males and females. In a sensitivity analysis excluding 'Assault' and 'Intentional self-harm', the probability increased markedly for males <1 year. All-cause mortality was 1.4% (n=10, 95% CI 0.7% to 2.6%). EMS had involved police in 17.6% and social authorities in 2.0%. CONCLUSION: Of all the children diagnosed with a suspected non-accidental or intentional self-harm injury in a hospital in Denmark, only a small proportion had been brought to the hospital by the EMS. Two-thirds of the injuries had been inflicted by another person, while a third was due to intentional self-harm. Involvement of legal or social authorities by EMS was uncommon.