Khurshid Muhammad Haris, Colosimo Christina, Hejazi Omar, Nelson Adam, Al Ma'ani Mohammad, Anand Tanya, Castillo Diaz Francisco, Ditillo Michael, Magnotti Louis J, Joseph Bellal
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2025 Sep 1;99(3):439-445. doi: 10.1097/TA.0000000000004587. Epub 2025 Mar 3.
Suicide is the second leading cause of death among adolescents aged 10 years to 17 years. The aim of this study was to examine a nationwide database to identify prevalence, injury patterns, outcomes, and disparities in the receipt of mental health care (MHC) in adolescents presenting following an attempted suicide at US trauma centers (TCs).
This is a 5-year (2017-2021) retrospective cohort analysis of the pediatric ACS-TQIP database. All adolescents (aged 10-17 years) presenting following a suicide attempt were included. Patients with superficial minor lacerations were excluded from the study. Outcomes measured were mortality rate among all adolescent patients who presented following a suicide attempt and rates of receiving MHC among survivors. Backward stepwise regression analyses were performed to identify predictors of outcomes.
A total of 3,738 adolescent patients presented to TCs after an attempt at suicide. The prevalence of suicide attempts increased (13.8 cases/1000 TC discharges in 2017 to 14.2 cases/1000 TC discharges in 2021; p < 0.001). Overall, 27% died during the index admission. Among survivors, the median age was 15 years, 64.8% patients were White, 15.6% Black, 16.0% Hispanic, 5.6% uninsured, and 37% were treated at a verified pediatric TC. Overall, 42.7% had a preinjury mental disorder. The most common mechanism of injury was cut/stab (28.3%), followed by firearms (24.3%), blunt mechanisms (20.9%), and asphyxiation (6.4%). Only 36% of survivors received MHC during index admission or on discharge. Firearm injuries, male gender, uninsured status, and Hispanic ethnicity were independent predictors of mortality. Moreover, male gender, Black race, Hispanic ethnicity, uninsured patients, and nonpediatric-verified TCs were associated with lower adjusted odds of receiving MHC.
The reported rate of violent suicide attempts in TC increased significantly over the years across the United States. There is a need for improved access to MHC for suicide attempt survivors. Our findings can serve to inform trauma registry data and policymakers by defining suicide attempt patterns and outcomes.
Therapeutic/Care Management; Level III.
自杀是10至17岁青少年的第二大死因。本研究旨在通过审查一个全国性数据库，以确定在美国创伤中心（TC）因自杀未遂就诊的青少年中，心理健康护理（MHC）的接受情况、损伤模式、结局及差异。
这是一项对儿科ACS-TQIP数据库进行的为期5年（2017 - 2021年）的回顾性队列分析。纳入所有因自杀未遂就诊的青少年（10 - 17岁）。研究排除了表浅轻微裂伤患者。测量的结局指标为所有因自杀未遂就诊的青少年患者的死亡率以及幸存者接受MHC的比例。进行向后逐步回归分析以确定结局的预测因素。
共有3,738名青少年患者在自杀未遂后前往创伤中心就诊。自杀未遂的发生率有所上升（从2017年的13.8例/1000例创伤中心出院患者增至2021年的14.2例/1000例创伤中心出院患者；p < 0.001）。总体而言，27%的患者在首次住院期间死亡。在幸存者中，中位年龄为15岁，64.8%为白人，15.6%为黑人，16.0%为西班牙裔，5.6%未参保，37%在经核实的儿科创伤中心接受治疗。总体而言，42.7%的患者在受伤前患有精神障碍。最常见的损伤机制是切割/刺伤（28.3%），其次是火器伤（2,4.3%）、钝性机制损伤（20.9%）和窒息（6.4%）。仅36%的幸存者在首次住院期间或出院时接受了MHC。火器伤、男性、未参保状态和西班牙裔种族是死亡率的独立预测因素。此外，男性、黑人种族、西班牙裔种族、未参保患者以及未经儿科核实的创伤中心与接受MHC的调整后几率较低相关。
多年来，美国创伤中心报告的暴力自杀未遂发生率显著上升。自杀未遂幸存者需要更好地获得MHC服务。我们的研究结果可通过定义自杀未遂模式和结局，为创伤登记数据及政策制定者提供参考。
治疗/护理管理；三级。
