1. The two faces of intentional self-inflicted injury: High in-hospital mortality, low postdischarge mortality, but high readmission rates
- Author
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Tonja M Locklear, Katie Love Bower, Tracey W. Criss, Julian C. Lagoy, Emily R. Faulks, Mark E. Hamill, Michael S. Nussbaum, Bryan R. Collier, Jennifer L. Bath, Miguel A. Matos, Daniel I Lollar, and Katherine L. Howe
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Poison control ,Kaplan-Meier Estimate ,030230 surgery ,National Death Index ,Patient Readmission ,Occupational safety and health ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Age Distribution ,Trauma Centers ,Injury prevention ,medicine ,Humans ,Hospital Mortality ,Registries ,Young adult ,Sex Distribution ,Survival analysis ,Univariate analysis ,Analysis of Variance ,Rehabilitation ,integumentary system ,business.industry ,Middle Aged ,Survival Analysis ,eye diseases ,United States ,Hospitalization ,030220 oncology & carcinogenesis ,Emergency medicine ,Self Mutilation ,Surgery ,Female ,business ,Self-Injurious Behavior - Abstract
Background Intentional self-inflicted injuries present unique challenges in treatment and prevention. We hypothesized intentional self-inflicted injuries would have higher in-hospital and postdischarge mortality than nonintentional self-inflicted injuries trauma. Methods Adult patients evaluated 2008 to 2012 were identified in our trauma registry and matched with mortality data from the National Death Index. Intentional self-inflicted injuries were identified using E-Codes. Readmissions were identified and analyzed. Intentional self-inflicted injuries patients who died in-hospital were compared with those surviving to discharge. Univariate analysis was performed using nonparametric tests. Kaplan-Meier curves were plotted to compare mortality ≤5 years postdischarge between intentional self-inflicted injuries and non-intentional self-inflicted injuries patients. Results In the study, 8,716 patient records were evaluated with 245 (2.8%) classified as intentional self-inflicted injuries. Eighteen (7.8%) patients with intentional self-inflicted injuries had multiple admissions, compared with 352 (4.4%) patients with nonintentional self-inflicted injuries with readmissions ( P = . 0210). In-hospital mortality was higher for intentional self-inflicted injuries compared with patients with non-intentional self-inflicted injuries (18.7% vs 4.9%, P 0001). Survival analysis demonstrated that patients with intentional self-inflicted injuries had significantly lower postdischarge mortality at multiple time points. Conclusion Patients with intentional self-inflicted injuries trauma have high in-hospital mortality, but low postdischarge mortality. We attribute this to high lethality mechanisms but appropriate psychiatric treatment and rehabilitation. However, the high intentional self-inflicted injuries readmission rate indicates further study of intentional self-inflicted injuries follow-up is warranted. Better prevention strategies are needed to identify and intervene in patients at-risk for intentional self-inflicted injuries.
- Published
- 2019