title: Epidemiology of suicide and the impact on Western trauma centers.
abstract: BACKGROUND
  Suicide represents the eleventh leading cause of death in the United States. Most suicides are a result of self-directed injury and are commonly treated in trauma centers. The purpose of this article is to characterize the epidemiology of suicide in the Western Mountain states and to describe the impact of these injuries on trauma centers.
  
  
  METHODS
  Data were accumulated from the National Trauma Data Bank, the American Association of Suicidology, and the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System. Variables analyzed included the epidemiology of suicide in relation to regional location, age, gender, mechanism of injury, mortality, disposition, Total Functional Independence Measure (TFIM) score, and length of stay in the intensive care unit versus the hospital floor. Statistical analysis was performed on select data points to demonstrate relative significance. Several comparisons were made among intentional injuries directed at oneself, at others, and unintentional injuries with respect to the above variables.
  
  
  RESULTS
  The Western region of the country has maintained the highest suicide rates since 1990, with 8 of the 10 Western Mountain states having rates twice as high as the national average. Approximately 88% of suicides presenting to trauma centers involve firearms, stabbings, or falls, usually causing injuries that lead to significant morbidity and mortality. Suicide attempts represent 2% of all admissions to trauma centers, with two thirds of these patient dying while in the hospital. Average length of stay in the intensive care unit and on hospital floors was 2.2 and 5.2 days, respectively, which was higher than the average length of stay of either unintentional injuries or intentional injuries directed at others.
  
  
  CONCLUSIONS
  The Western Mountain states represent an endemic region for suicide. Because of the violent nature of these injuries, they often require significant medical care and finances usually provided by state governments. Suicides also contribute to the morbidity and mortality in a disproportionate manner in comparison with motor vehicle crashes and homicides. In conclusion, the Western region bears a larger burden than other regions in caring for this subset of patients with respect to medical and financial resources. Increased public awareness and preventative measures can aid in reducing not only the overall incidence of suicide but also the patient load and costs that are incurred on this country's health care system.
authors.affiliation: Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada, USA.
authors.forename: Trina P V
authors.initials: TP
authors.lastname: Steljes
authors.forename: Lynn
authors.initials: L
authors.lastname: Fullerton-Gleason
authors.forename: Deborah
authors.initials: D
authors.lastname: Kuhls
authors.forename: G Thomas
authors.initials: GT
authors.lastname: Shires
authors.forename: John
authors.initials: J
authors.lastname: Fildes
mesh_terms: D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D013405:Suicide / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data