Self-inflicted penetrating injuries at a Level I Trauma Center.
BACKGROUND
Although gunshot and stab wounds are a common cause of self-inflicted injury, very little is understood about this mechanism of injury. The aim of this study was to characterise the epidemiology and outcomes of patients who injured themselves with a gun or sharp object.


METHODS
After IRB approval, the LAC+USC Trauma Registry was utilised to identify all patients who sustained a self-inflicted injury caused by firearm (GSW) or stabbing (SW) from 1997 to 2007. Demographic data, injury characteristics, surgical interventions, and outcomes were abstracted and analysed.


RESULTS
During the 11-year study period, a total of 753 patients (1.6%) were admitted for a self-inflicted injury. Of these, 369 (49.0%) had a self-inflicted penetrating injury, with 72 (19.5%) having sustained a GSW and 297 (80.5%) having a SW. Overall, the mean age was 36.4+/-15.8 years, 83.5% were male, with a mean ISS of 7.4+/-11.0. The most commonly injured body region in GSW patients was the head (76.4%), followed by the chest (15.3%) and in SW patients the upper extremity (37.0%), followed by the abdomen (36.4%). When compared to SW, GSW were significantly more frequent in males (21.4% vs. 9.8%, p=0.04), and were most commonly to the head (21.4% vs. 8.2%, p=0.02). Patients sustaining a GSW were more likely to be older than 55 years (22.2% vs. 8.4%, p<0.001). Intoxication was noted at presentation in 38.3% of screened GSW patients and 39.9% of SW patients. SW patients required operative intervention more frequently (40.9% vs. 22.2%, p<0.01), with 12.8% of them requiring exploratory laparotomy. However, patients who shot themselves were much more likely to die (66.7%) than those presenting with SW (1.7%). For those presenting with a GSW to the head, the mortality rate was even higher, at 80%. Mortality did not differ between males and females in either group.


CONCLUSIONS
Although a self-inflicted SW is far more common than a self-inflicted GSW, patients sustaining a GSW are more severely injured, and have a nearly 110-fold increased risk of death. Though less lethal, stab wounds still consume significant amounts of healthcare resources and incur large in-hospital costs. The average hospital charge incurred for treating these self-inflicted injuries was five times the amount spent per annum on American citizens. Self-inflicted penetrating injuries represent a golden opportunity for secondary prevention through psychiatric intervention. These interventions may not only preserve life but also improve resource utilisation.
Bukur
Marko
M
Division of Acute Care Surgery, Trauma, Emergency Surgery and Surgical Critical Care, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA 90033, United States.
Inaba
Kenji
K
Barmparas
Galinos
G
DuBose
Joseph J
JJ
Lam
Lydia
L
Branco
Bernardino C
BC
Lustenberger
Thomas
T
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014951:Wounds, Stab / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055815:Young Adult