Are patients with self-inflicted injuries more likely to die?
BACKGROUND
Suicide represents one of the leading causes of trauma in industrialized countries. However, when compared with unintentional injury and assault, the outcome of self-inflicted injury has not been well described.


METHODS
All patients admitted to a French academic trauma center from January 2002 to December 2004 and listed in a trauma data bank were included in a prospective analysis. Variables including mortality, circumstances (unintentional vs. assault vs. self-inflicted), and mechanism of injury were recorded.


RESULTS
About 1,004 continuous trauma patients were analyzed: 151 (15%) with self-inflicted injuries, 761 (76%) with unintentional injuries, and 91 (9%) with injuries from assault. When compared with patients suffering from unintentional injuries and assault, self-inflicted injury patients presented more frequently after a fall from height (94 of 151 vs. 133 of 759 and 0 of 91, p < 0.05) and with a severe head injury (47 of 151 vs. 172 of 752 and 10 of 91, p < 0.05). They also had a more severe injury (Injury Severity Score, 28 +/- 21 vs. 22 +/- 16 and 12 +/- 10; p < 0.05), a lower probability of survival (Trauma Related Injury Severity Score, 0.71 +/- 0.37 vs. 0.83 +/- 0.28 and 0.92 +/- 0.19; p < 0.05), and survival rate (70% vs. 85% and 93%, p < 0.05). In multivariate analysis, Trauma Related Injury Severity Score (odds ratio, 0.54; 95% confidence interval, 0.45-0.59; p < 0.001), age (odds ratio, 1.17; confidence interval, 1.02-1.34; p < 0.05), and mechanism of trauma (p = 0.01) were independently correlated with the final mortality rate.


CONCLUSIONS
Self-inflicted injury patients presented with a higher mortality rate that was related to increased injury severity. The circumstances surrounding the trauma were not independently associated with an increased odds ratio of death after major trauma.
David
Jean-Stephane
JS
Hospices Civils de Lyon, Department of Anesthesiology, Critical Care and EMS, Edouard Herriot Hospital, Lyon, France. js-david@univ-lyon1.fr
Gelas-Dore
Benedicte
B
Inaba
Kenji
K
Levrat
Albrice
A
Riou
Bruno
B
Gueugniaud
Pierre-Yves
PY
Schott
Anne-Marie
AM
D000059:Accidents / Q000706:statistics & numerical data*; D000328:Adult; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D035481:Retrospective Moral Judgment; D016728:Self-Injurious Behavior / Q000401:mortality*; D014754:Violence / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*