title: Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan.
abstract: BACKGROUND
  Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service (EMS) personnel.
  
  
  METHODS
  This study retrospectively reviewed population-based ambulance records in Osaka City, Japan, between January 2010 and December 2012, and enrolled emergency patients who suffered from self-inflicted injuries such as poisoning by drugs or gas, cutting/piercing skin, jumping from heights, hanging, and drowning. The endpoint was the annual incidence per 100,000 populations in Osaka City of emergency patients who presented with self-inflicted injuries by age and sex. Their outcomes including deaths at the scene and hospital arrival were also evaluated.
  
  
  RESULTS
  During the study period, a total of 8,671 patients with 9,424 incidents of self-inflicted injuries were documented. The annual incidence of self-inflicted injuries was higher among women than men in the whole population and in the age group < =49 years (136.9 versus 82.6, and 214.8 versus 93.3, both Ps < 0.001), but it was inversely lower among women in the age group > =50 years (49.0 versus 68.9, P < 0.001). The total number of self-inflicted deaths was 1,564 (16.6 %), and the overall proportion of self-inflicted deaths was greater among men than women (32.2 % [1075/3340] vs. 7.5 % [451/6027], P < 0.001). The proportion of self-inflicted hanging was 76.7 % [1142/1489], followed by poisoning by carbon monoxide at 57.1 % [56/98] and jumping to death at 47.6 % [254/534].
  
  
  CONCLUSIONS
  Using large-scale EMS records, we investigated characteristics and outcomes of emergency patients with self-inflicted injuries treated by EMS personnel. Our findings suggested the gender paradox that the proportion of self-inflicted deaths was higher among men than women, while the proportion of non-fatal self-inflicted injuries was higher among women than among men, particularly in the group aged <=49 years. Our findings showing the importance of the prevention for self-inflicted injuries as well as the gender paradox of self-inflicted injuries will provide important epidemiological information to improve psychiatric cares in prehospital emergency settings.
  
  
  CONCLUSIONS
  In the total population, the annual incidence of self-inflicted injuries responded to by EMS personnel was higher among women than among men. However, the proportion of self-inflicted deaths was greater among men than women, and the most frequent manner among deceased patients was by hanging.
authors.affiliation: Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-0841, Japan. task-m@koto.kpu-m.ac.jp.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Matsuyama
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Public Health, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kiyohara
authors.affiliation: Osaka Municipal Fire Department, 1-12-54 Kujo Minami, Nishi-ku, Osaka, 550-8566, Japan.
authors.forename: Sumito
authors.initials: S
authors.lastname: Hayashida
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.affiliation: Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-0841, Japan.
authors.forename: Bon
authors.initials: B
authors.lastname: Ohta
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000552:Ambulances / Q000706:statistics & numerical data*; D002648:Child; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000628:therapy; D017678:Sex Distribution; D055815:Young Adult
keywords: Emergency medical service; Epidemiology; Population-based study; Self-inflicted injuries