Kiankhooy Armin, Crookes Bruce, Privette Alicia, Osler Turner, Sartorelli Kennith
Department of Surgery, Division of Trauma/Critical Care, University of Vermont College of Medicine/Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
J Trauma. 2009 Aug;67(2):366-71. doi: 10.1097/TA.0b013e3181ae81d5.
Over the past 20 years, the rate of suicide in rural communities has surpassed those of urban areas. The number of rural trauma patients who attempt suicide, are treated and survive at a trauma center, but ultimately reattempt suicide and succeed (suicide recidivists) is unknown. We have characterized all adult suicide deaths seen at a rural Level I trauma center and identified predictors of a successful suicide. We hypothesized that rural adult trauma patients exhibit a high rate of suicide recidivism.
This is a 10-year single institutional retrospective cohort analysis. All adult admissions to our rural, Level I trauma center from 1997 to 2007 (n = 9147) were cross referenced with a Vermont Medical Examiner database containing information regarding all suicide deaths in the state of Vermont from 2002 to 2007 (n = 502); the 32 matches are the subject of this research.
One half (16 of 32) of patients who died by suicide had a previous admission to the trauma service. Index hospital length of stay (LOS, p < 0.02), intensive care unit-LOS (p < 0.01), and ventilator days (p < 0.01) were significantly different between trauma patients who subsequently died by suicide and general trauma patients. The average delay from initial presentation to suicide death was 2.8 years. Eighteen of 28 (64%) of suicide attempters had previous trauma admissions for self-inflicted injury (p < 0.001). Eighteen of 156 (12%) of previous self-inflicted injury admissions resulted in future suicide attempt (NNT = 9). A logistic regression model identified the following variables present at the index hospitalization as significant predictors of future suicide: self-inflicted injury, penetrating mechanism of injury, longer hospital LOS, younger age, and female gender.
The overwhelming majority (94%) of suicide deaths in our rural state were never seen by the trauma center, and only 1.1% were recidivists. Previous admissions for self-inflicted injuries or penetrating injuries were significant predictors of future suicide attempt and should trigger select interventions. Other factors that can to lead a suicidal tendency include a previous mental health history (depression), poly-substance abuse, and chronic pain history. In our small sample, suicidal tendencies could persist for a prolonged period of time.
在过去20年里，农村社区的自杀率已超过城市地区。农村创伤患者试图自杀、在创伤中心接受治疗并存活下来，但最终再次自杀并成功（自杀累犯）的人数尚不清楚。我们已对一家农村一级创伤中心所见的所有成人自杀死亡病例进行了特征描述，并确定了自杀成功的预测因素。我们假设农村成年创伤患者的自杀累犯率很高。
这是一项为期10年的单机构回顾性队列分析。1997年至2007年期间入住我们农村一级创伤中心的所有成年患者（n = 9147）与佛蒙特州医学检验员数据库进行了交叉比对，该数据库包含2002年至2007年佛蒙特州所有自杀死亡病例的信息（n = 502）；32例匹配病例是本研究的对象。
自杀死亡患者中有一半（32例中的16例）曾入住创伤科。随后自杀死亡的创伤患者与一般创伤患者在首次住院住院时间（LOS，p < 0.02）、重症监护病房住院时间（p < 0.01）和呼吸机使用天数（p < 0.01）方面存在显著差异。从首次就诊到自杀死亡的平均延迟时间为2.8年。28例自杀未遂者中有18例（64%）曾因自残伤入住创伤科（p < 0.001）。156例既往自残伤住院患者中有18例（12%）日后企图自杀（需治疗人数 = 9）。逻辑回归模型确定了首次住院时存在的以下变量是未来自杀的显著预测因素：自残伤、穿透性损伤机制、住院时间较长、年龄较小和女性。
在我们这个农村州，绝大多数（94%）自杀死亡病例创伤中心从未见过，只有1.1%是累犯。既往因自残伤或穿透性损伤住院是未来自杀企图的重要预测因素，应触发特定干预措施。其他可能导致自杀倾向的因素包括既往心理健康史（抑郁症）、多种物质滥用和慢性疼痛史。在我们的小样本中，自杀倾向可能会持续很长时间。
