Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA; Carilion Clinic, Roanoke, VA.
Carilion Clinic, Roanoke, VA.
Surgery. 2019 Oct;166(4):580-586. doi: 10.1016/j.surg.2019.04.037. Epub 2019 Jul 15.
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.
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.
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.
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.
蓄意自伤在治疗和预防方面带来了独特的挑战。我们假设，蓄意自伤患者的院内和出院后死亡率会高于非蓄意自伤创伤患者。
在我们的创伤登记处中确定了 2008 年至 2012 年期间接受评估的成年患者，并与国家死亡指数的死亡率数据进行了匹配。使用 E 编码识别蓄意自伤。确定并分析了再入院患者。将住院期间死亡的蓄意自伤患者与存活至出院的患者进行比较。使用非参数检验进行单变量分析。绘制 Kaplan-Meier 曲线以比较蓄意自伤和非蓄意自伤患者出院后 5 年内的死亡率。
在研究中，评估了 8716 份患者记录，其中 245 例（2.8%）被归类为蓄意自伤。18 例（7.8%）蓄意自伤患者有多次入院，而 352 例（4.4%）非蓄意自伤患者有再入院（P=0.0210）。与非蓄意自伤患者相比，蓄意自伤患者的院内死亡率更高（18.7% vs 4.9%，P<0.0001）。生存分析表明，蓄意自伤患者在多个时间点的出院后死亡率明显较低。
蓄意自伤创伤患者的院内死亡率较高，但出院后死亡率较低。我们将其归因于高致死机制，但适当的精神科治疗和康复。然而，高蓄意自伤再入院率表明需要进一步研究蓄意自伤的随访情况。需要制定更好的预防策略，以识别和干预有蓄意自伤风险的患者。
