title: Fait accompli: suicide in a rural trauma setting.
abstract: OBJECTIVE
  Over the past 20 years, the rate of suicide in rural communities has surpassed those of urban areas. The number of rural trauma patients who attempt suicide, are treated and survive at a trauma center, but ultimately reattempt suicide and succeed (suicide recidivists) is unknown. We have characterized all adult suicide deaths seen at a rural Level I trauma center and identified predictors of a successful suicide. We hypothesized that rural adult trauma patients exhibit a high rate of suicide recidivism.
  
  
  METHODS
  This is a 10-year single institutional retrospective cohort analysis. All adult admissions to our rural, Level I trauma center from 1997 to 2007 (n = 9147) were cross referenced with a Vermont Medical Examiner database containing information regarding all suicide deaths in the state of Vermont from 2002 to 2007 (n = 502); the 32 matches are the subject of this research.
  
  
  RESULTS
  One half (16 of 32) of patients who died by suicide had a previous admission to the trauma service. Index hospital length of stay (LOS, p < 0.02), intensive care unit-LOS (p < 0.01), and ventilator days (p < 0.01) were significantly different between trauma patients who subsequently died by suicide and general trauma patients. The average delay from initial presentation to suicide death was 2.8 years. Eighteen of 28 (64%) of suicide attempters had previous trauma admissions for self-inflicted injury (p < 0.001). Eighteen of 156 (12%) of previous self-inflicted injury admissions resulted in future suicide attempt (NNT = 9). A logistic regression model identified the following variables present at the index hospitalization as significant predictors of future suicide: self-inflicted injury, penetrating mechanism of injury, longer hospital LOS, younger age, and female gender.
  
  
  CONCLUSIONS
  The overwhelming majority (94%) of suicide deaths in our rural state were never seen by the trauma center, and only 1.1% were recidivists. Previous admissions for self-inflicted injuries or penetrating injuries were significant predictors of future suicide attempt and should trigger select interventions. Other factors that can to lead a suicidal tendency include a previous mental health history (depression), poly-substance abuse, and chronic pain history. In our small sample, suicidal tendencies could persist for a prolonged period of time.
authors: Department of Surgery, Division of Trauma/Critical Care, University of Vermont College of Medicine/Fletcher Allen Health Care, Burlington, Vermont 05401, USA. armin.kiankhooy@vtmednet.org
authors: Armin
authors: A
authors: Kiankhooy
authors: Bruce
authors: B
authors: Crookes
authors: Alicia
authors: A
authors: Privette
authors: Turner
authors: T
authors: Osler
authors: Kennith
authors: K
authors: Sartorelli
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population; D016728:Self-Injurious Behavior / Q000453:epidemiology; D012923:Social Class; D013405:Suicide / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014707:Vermont / Q000453:epidemiology