title: Factors affecting survival following self-inflicted head and neck gunshot wounds: a single-centre retrospective review.
abstract: Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records (n=157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the χ(2) test or Fisher's exact test for statistical difference testing. Outcomes recorded were death (n=92, 59%), discharge to long-term care/rehabilitation (n=58, 37%), and discharge home (n=7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system (n=127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury (P=0.025). A tracheostomy within 24h of admission was statistically associated with improved survival (P<0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA. Electronic address: james.anthony.murphy@gmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Murphy
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Lee
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: G
authors.initials: G
authors.lastname: Warburton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000601:surgery*; D012189:Retrospective Studies; D013406:Suicide, Attempted; D015996:Survival Rate; D014948:Wounds, Gunshot / Q000601:surgery*
keywords: gunshot; head and neck; suicide