title: Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm.
abstract: BACKGROUND
  Self-harm and intentional injuries represent a significant public health concern. People who survive serious injury from self-harm can experience poor outcomes that negatively impact on their daily life. The aim of this study was to investigate a cohort of major trauma patients hospitalised for self-harm in Victoria, and to identify risk factors for longer term mortality, functional recovery and return to work.
  
  
  METHODS
  482 adult major trauma patients who were injured due to self-harm and survived to hospital discharge, and were captured by the population-based Victorian State Trauma Registry (VSTR), were included. For those with a date of injury from January 1, 2007 to December 31, 2013, demographics and injury event data, Glasgow Outcome Scale Extended (GOS-E) and return to work (RTW) outcomes at 6, 12 and 24 months post-injury were extracted from the registry. Post-discharge mortality was identified through the Victorian Registry of Births, Deaths and Marriages (BDM). Multivariable logistic regression was used to determine predictors of the GOS-E and RTW and survival analysis was used to identify predictors of mortality.
  
  
  RESULTS
  A total of 37 (7.7%) deaths occurred post-discharge. There were no clear predictors of all-cause mortality. Overall, 36% of patients reported making a good recovery at 24 months. Older age (p=0.01), transport-related methods of self-harm (p=0.02), higher Injury Severity Score (p<0.001) and having a Charlson Comorbidity Index weighting of one or more (p=0.02) were predictive of poorer functional recovery. Of patients who were working or studying prior to injury, 54% reported returning to work by 24 months post-injury. Higher Injury Severity Score was an important predictor of not returning to work (p=0.002).
  
  
  CONCLUSIONS
  The vast majority of major trauma patients who self-harmed and survived to hospital discharge were alive at two years post-injury, yet only half of this cohort returned to work and just over a third of patients experienced a good recovery.
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road Melbourne VIC 3004, Australia. Electronic address: tu.nguyen@monash.edu.
authors.forename: Tu Q
authors.initials: TQ
authors.lastname: Nguyen
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road Melbourne VIC 3004, Australia. Electronic address: pamela.simpson@monash.edu.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Simpson
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road Melbourne VIC 3004, Australia. Electronic address: sandra.braaf@monash.edu.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Braaf
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road Melbourne VIC 3004, Australia; Farr Institute at the Centre for Improvement in Population Health through E-records Research (CIPHER), Swansea University Medical School, Swansea University, United Kingdom. Electronic address: belinda.gabbe@monash.edu.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence; D020127:Recovery of Function; D012042:Registries / Q000706:statistics & numerical data; D062707:Return to Work / Q000523:psychology / Q000706:statistics & numerical data*; D016728:Self-Injurious Behavior / Q000401:mortality* / Q000503:physiopathology* / Q000523:psychology; D016019:Survival Analysis; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult
keywords: Deliberate self-harm; Functional; Return to work (RTW); Trauma