Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark

Kristine Sørensen; Morten Breinholt Søvsø; Charlotte Nørkjær Eggertsen; Giles Haythornthwaite; Søren Mikkelsen; Erika Frischknecht Christensen; Vibe Maria Laden Nielsen

doi:10.1136/bmjpo-2026-004764

Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark

Kristine Sørensen
, Morten Breinholt Søvsø
, Charlotte Nørkjær Eggertsen
, Giles Haythornthwaite
, Søren Mikkelsen
, Erika Frischknecht Christensen^*
, Vibe Maria Laden Nielsen

^*Kontaktforfatter

Aalborg Universitetshospital
Aalborg Universitet
Bristol Royal Hospital for Children

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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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.

Originalsprog	Engelsk
Artikelnummer	e004764
Tidsskrift	BMJ Paediatrics Open
Vol/bind	10
Udgave nummer	1
Antal sider	11
ISSN	2399-9772
DOI	https://doi.org/10.1136/bmjpo-2026-004764
Status	Udgivet - jun. 2026

Bibliografisk note

Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.

Finansiering

This work was supported by the Danish Air Ambulance with a research grant for VMLN [grant date 27092024]. EFC and SM are members of the research committee; however, neither of them was a party to the decision to support the grant application in question. The committee had the opportunity to comment on the study protocol. Outside the submitted work, EFC was supported by an unrestricted grant to her professorship [grant number 20046/aau] from the philanthropic fund TrygFonden to Aalborg University. The funders had no role in the conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication in this specific scientific journal. The authors appreciate the help in the data collection process provided by statistician Torben Anders Kløjgård, MSc and senior researcher Tim Lindskou, MSc, PhD, from the Centre for Prehospital and Emergency Research at Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Denmark.

Dokumenter og links

10.1136/bmjpo-2026-004764Licens: CC BY-NC

Open Access VersionForlagets udgivne version, 921 KBLicens: CC BY-NC

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

Sørensen, K., Søvsø, M. B., Eggertsen, C. N., Haythornthwaite, G., Mikkelsen, S., Christensen, E. F., & Nielsen, V. M. L. (2026). 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, 10(1), Artikel e004764. https://doi.org/10.1136/bmjpo-2026-004764

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title = "Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark",

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 {\textquoteleft}Asphyxiation{\textquoteright} (2.5\%), {\textquoteleft}Maltreatment{\textquoteright} (15.1\%), {\textquoteleft}Assault{\textquoteright} (31.2\%), {\textquoteleft}Sexual abuse{\textquoteright} (5.9\%), {\textquoteleft}Intentional self-harm{\textquoteright} (28.7\%) and {\textquoteleft}>1 of the above categories{\textquoteright} (16.6\%). Children aged 12{\textendash}15 years had a higher probability of these injuries, both in males and females. In a sensitivity analysis excluding {\textquoteleft}Assault{\textquoteright} and {\textquoteleft}Intentional self-harm{\textquoteright}, 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.",

keywords = "Child Abuse, Child Health, Epidemiology, Health services research",

author = "Kristine S{\o}rensen and S{\o}vs{\o}, \{Morten Breinholt\} and Eggertsen, \{Charlotte N{\o}rkj{\ae}r\} and Giles Haythornthwaite and S{\o}ren Mikkelsen and Christensen, \{Erika Frischknecht\} and Nielsen, \{Vibe Maria Laden\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.",

year = "2026",

month = jun,

doi = "10.1136/bmjpo-2026-004764",

language = "English",

volume = "10",

journal = "BMJ Paediatrics Open",

issn = "2399-9772",

publisher = "BMJ Publishing Group",

number = "1",

}

Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark. / Sørensen, Kristine; Søvsø, Morten Breinholt; Eggertsen, Charlotte Nørkjær et al.
I: BMJ Paediatrics Open, Bind 10, Nr. 1, e004764, 06.2026.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call

T2 - a national population-based cohort study from Denmark

AU - Sørensen, Kristine

AU - Søvsø, Morten Breinholt

AU - Eggertsen, Charlotte Nørkjær

AU - Haythornthwaite, Giles

AU - Mikkelsen, Søren

AU - Christensen, Erika Frischknecht

AU - Nielsen, Vibe Maria Laden

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.

PY - 2026/6

Y1 - 2026/6

N2 - 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.

AB - 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.

KW - Child Abuse

KW - Child Health

KW - Epidemiology

KW - Health services research

U2 - 10.1136/bmjpo-2026-004764

DO - 10.1136/bmjpo-2026-004764

M3 - Journal article

C2 - 42264910

AN - SCOPUS:105041267274

SN - 2399-9772

VL - 10

JO - BMJ Paediatrics Open

JF - BMJ Paediatrics Open

IS - 1

M1 - e004764

ER -

Paediatric suspected non-accidental or intentional self-harm injuries diagnosed after an emergency call: a national population-based cohort study from Denmark

Abstract

Bibliografisk note

Finansiering

Dokumenter og links

SDU link

Fingeraftryk

Citationsformater