自伤性枪伤：美国创伤中心的回顾性观察研究。
Self-Inflicted Gun Shot Wounds: A Retrospective, Observational Study of U.S. Trauma Centers.
机构信息
University of California, San Diego, Department of Emergency Medicine, San Diego, California.
Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California.
出版信息
West J Emerg Med. 2021 May 19;22(3):518-524. doi: 10.5811/westjem.2021.4.49315.
INTRODUCTION
Intentional self-harm (suicide) by firearms is a growing problem in the United States. Currently, there are no large studies that have identified risk factors for patients who die from self-inflicted gunshot wounds. Our objectives are to 1) identify risk factors for patients with the highest morbidity and mortality from self-inflicted gunshot wounds (SIGSWs) at trauma centers 2) present the outcomes of victims of SIGSW by handguns (HG) versus all other specified guns (AOG) and 3) compare the presentations and outcomes of victims with head or face (HF) injuries to other regions of the body.
METHODS
We performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all SIGSW patients who presented to trauma centers. Categorical data included patient characteristics upon presentation and outcomes which were compared between patients with HG injury versus AOG injury using the Chi-Squared test, where AOG includes shotguns, hunting rifles, and military firearms. Additionally, analysis of head and face (HF) injuries versus other bodily injuries (OBI) were compared between the HG group versus AOG group using Chi-squared test.
RESULTS
There were 7,828 SIGSWs, of those, 78% (6,115) were white and 84.3% (6,600) were male. There were 5,139 HG injuries, 1,130 AOG injuries, and 1,405 unidentified gun injuries. The HG group was likely to be older (>55 years old), hypotensive (systolic blood pressure < 90), have a lower Glasgow Coma Score (GCS < 9), use illegal, or use prescription drugs. In comparing HF injuries (4,799) versus other bodily injuries (OBI) (3,028), HF group was more likely to use handguns, expire in ED, require ICU, and have a higher percent of overall mortality. Of the total OBI, the thorax, upper extremities, and abdomen were the most commonly injured.
CONCLUSION
In our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms. SIGSWs in older white males with handguns are the most at-risk for severe complications. Future efforts should improve screening methods for handguns in suicidal patients and at developing prevention programs.
简介
在美国，蓄意用枪支自杀（自杀）是一个日益严重的问题。目前，尚无大型研究确定在创伤中心因自杀性枪伤而死亡的患者的风险因素。我们的目标是 1）确定在创伤中心因自杀性枪伤（SIGSW）而死亡率和发病率最高的患者的风险因素，2）通过手枪（HG）和所有其他指定枪支（AOG）对 SIGSW 受害者的结果进行说明，3）比较头部或面部（HF）受伤与其他身体部位受伤的受害者的表现和结果。
方法
我们对 2012 年至 2013 年期间所有在创伤中心就诊的 SIGSW 患者进行了国家创伤数据库（NTDB）数据的回顾性分析。分类数据包括患者就诊时的特征和结果，并使用卡方检验比较 HG 损伤与 AOG 损伤的患者之间的差异，其中 AOG 包括猎枪、猎枪和军用枪支。此外，还使用卡方检验比较 HG 组与 AOG 组之间头部和面部（HF）损伤与其他身体损伤（OBI）的差异。
结果
有 7828 例 SIGSW，其中 78％（6115 例）为白人，84.3％（6600 例）为男性。有 5139 例 HG 损伤，1130 例 AOG 损伤和 1405 例未识别枪支损伤。HG 组更有可能年龄较大（> 55 岁），血压较低（收缩压<90），格拉斯哥昏迷评分（GCS<9）较低，使用非法或处方药物。在比较头部和面部（HF）损伤（4799 例）与其他身体损伤（OBI）（3028 例）时，HF 组更有可能使用手枪，在 ED 时死亡，需要 ICU，整体死亡率更高。在总 OBI 中，胸部，上肢和腹部是最常见的受伤部位。
结论
在对 SIGSW 的回顾性研究中，我们能够证明与所有其他类型的枪支相比，用手枪进行 SIGSW 与更高的死亡率相关。使用手枪的老年白人男性的 SIGSW 风险最高，并发症最严重。未来的工作应改善对自杀患者的手枪筛查方法，并制定预防计划。
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