Rajasingh Charlotte M, Tennakoon Lakshika, Staudenmayer Kristan L
Stanford University, Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford, California.
Stanford University, Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford, California.
J Surg Res. 2018 Mar;223:22-28. doi: 10.1016/j.jss.2017.10.009. Epub 2017 Nov 10.
Self-inflicted gunshot wounds (SI-GSWs) are often fatal, but roughly 20% of individuals survive. What happens to survivors after the initial hospitalization is unknown. We hypothesized that the SI-GSW survivors are frequently readmitted and that the pattern of readmission is different from that of the survivors of non-GSW self-harm (SH).
We conducted a retrospective cohort analysis using the 2013 and 2014 Nationwide Readmission Database. Patients with any diagnosis indicating deliberate SH in the first 6 months of the year were included. This group was divided into those who had SI-GSW as their mechanism and those who did not. Weighted numbers are reported.
A total of 1987 patients were admitted for SI-GSW in the study period. Many (n = 506, 26%) experienced at least one readmission in 6 months. When compared with non-GSW SH patients, readmission rates were not statistically different (26% versus 26%, P = 0.60). However, readmissions for repeat SH were lower for the SI-GSW cohort (3% versus 7%, P = 0.004). Readmission for the SI-GSW cohort less frequently had a primary diagnosis of psychiatric illness (28% versus 57%, P < 0.001). In multivariate analysis, there was no difference in odds ratios (OR) of all-cause readmission between the two groups. SI-GSW was associated with a lower OR of repeat SH readmission compared with non-GSW SH (OR 0.65, P = 0.039).
Readmissions after an SI-GSW are frequent, highlighting the burden of this injury beyond the index hospitalization. There are differences in readmission patterns for SI-GSW patients versus non-GSW SH patients, and this suggests that prevention and follow-up strategies may differ between the two groups.
自我造成的枪伤（SI-GSW）通常是致命的，但约20%的患者能够存活。初始住院后幸存者的情况尚不清楚。我们推测，SI-GSW幸存者经常再次入院，且再次入院模式与非枪伤性自我伤害（SH）幸存者不同。
我们使用2013年和2014年全国再入院数据库进行了一项回顾性队列分析。纳入当年前6个月有任何故意自我伤害诊断的患者。该组分为以SI-GSW为致伤机制的患者和非SI-GSW致伤机制的患者。报告加权数量。
在研究期间，共有1987例患者因SI-GSW入院。许多患者（n = 506，26%）在6个月内至少有一次再次入院。与非GSW SH患者相比，再次入院率无统计学差异（26%对26%，P = 0.60）。然而，SI-GSW队列中因重复自我伤害的再次入院率较低（3%对7%，P = 0.004）。SI-GSW队列再次入院时以精神疾病作为主要诊断的情况较少（28%对57%，P < 0.001）。在多变量分析中，两组全因再次入院的比值比（OR）无差异。与非GSW SH相比，SI-GSW与重复自我伤害再次入院的OR较低相关（OR 0.65，P = 0.039）。
SI-GSW后再次入院很常见，突出了该损伤在首次住院之外的负担。SI-GSW患者与非GSW SH患者的再次入院模式存在差异，这表明两组的预防和随访策略可能不同。
