Characteristics and Outcomes of Patients with Self-directed Violence Presenting to Trauma Centers in the United States.

Abstract

Introduction: Psychiatric conditions are common presentations to the emergency department, and their prevalence has been steadily increasing. Part of this spectrum of presentations is self-directed violence. Self-directed violence involves suicidal acts and non-suicidal self-injuries that can result in serious morbidity and mortality. This study examines characteristics and outcomes of patients who presented to US trauma centers with self-inflicted injuries and identifies factors associated with survival to hospital discharge in this patient population.

Methods: We extracted data in a retrospective, observational manner from the 2020 National Trauma Data Bank (NTDB) 2020. The NTDB includes data from over 900 trauma centers (900/2,294 total trauma centers in the United States, 39.2%). We performed a descriptive analysis of characteristics, injury patterns and outcomes. All variables were tabulated by outcome (died: yes/no). We then conducted a multivariable logistic regression using a stepwise technique to identify factors associated with the patients' survival to hospital discharge.

Results: A total of 12,824 patients with self-inflicted injuries were included in this analysis. Their median age was 35 years (interquartile range 25-50), and they were mostly males (74.7%) and White (69.6%). Patients were mostly transported by ground ambulance (78.9%) to Level I (60.6%) and Level II (33.5%) trauma centers. Most patients had a pre-existing condition (70.2%). These included mental/personality disorder (48.2%), alcohol use disorder (11.5%), and substance use disorder (17.7%). The most common mechanism of injury was penetrating trauma (71.6%), followed by blunt trauma (18.0%) and burns (1%). Cutting/piercing was the most common penetrating mechanism (60%) compared with firearm-related trauma (40%). Severe injury (Injury Severity Score ≥ 16) was present in 32.8% of patients. A positive alcohol screen and/or a positive drug screen were reported in 30.2% and 31.2% of patients, respectively. Most patients were admitted to hospital (86%). Overall mortality rate at hospital discharge was 21.7%. We identified Important factors associated with survival to hospital discharge in this patient population.

Conclusion: Patients with self-inflicted injuries treated at US trauma centers have high rates of injury severity and a high mortality rate. This study sheds light on the complex and resource-intensive care needed for this vulnerable patient population.