Jasani Gregory, Cavaliere Garrett, Bachir Rana, Van Remmen Sarah, El Sayed Mazen
University of Maryland School of Medicine, Baltimore, Department of Emergency Medicine, Baltimore, Maryland.
Penn State College of Medicine, Department of Emergency Medicine, Hershey, Pennsylvania.
West J Emerg Med. 2025 Jul 18;26(4):1008-1020. doi: 10.5811/westjem.42022.
Psychiatric conditions are common presentations to the emergency department, and their prevalence has been steadily increasing. Part of this spectrum of presentations is self-directed violence. Self-directed violence involves suicidal acts and non-suicidal self-injuries that can result in serious morbidity and mortality. This study examines characteristics and outcomes of patients who presented to US trauma centers with self-inflicted injuries and identifies factors associated with survival to hospital discharge in this patient population.
We extracted data in a retrospective, observational manner from the 2020 National Trauma Data Bank (NTDB) 2020. The NTDB includes data from over 900 trauma centers (900/2,294 total trauma centers in the United States, 39.2%). We performed a descriptive analysis of characteristics, injury patterns and outcomes. All variables were tabulated by outcome (died: yes/no). We then conducted a multivariable logistic regression using a stepwise technique to identify factors associated with the patients' survival to hospital discharge.
A total of 12,824 patients with self-inflicted injuries were included in this analysis. Their median age was 35 years (interquartile range 25-50), and they were mostly males (74.7%) and White (69.6%). Patients were mostly transported by ground ambulance (78.9%) to Level I (60.6%) and Level II (33.5%) trauma centers. Most patients had a pre-existing condition (70.2%). These included mental/personality disorder (48.2%), alcohol use disorder (11.5%), and substance use disorder (17.7%). The most common mechanism of injury was penetrating trauma (71.6%), followed by blunt trauma (18.0%) and burns (1%). Cutting/piercing was the most common penetrating mechanism (60%) compared with firearm-related trauma (40%). Severe injury (Injury Severity Score ≥ 16) was present in 32.8% of patients. A positive alcohol screen and/or a positive drug screen were reported in 30.2% and 31.2% of patients, respectively. Most patients were admitted to hospital (86%). Overall mortality rate at hospital discharge was 21.7%. We identified Important factors associated with survival to hospital discharge in this patient population.
Patients with self-inflicted injuries treated at US trauma centers have high rates of injury severity and a high mortality rate. This study sheds light on the complex and resource-intensive care needed for this vulnerable patient population.
精神疾病是急诊科常见的就诊情况，其患病率一直在稳步上升。这类就诊情况的一部分是自我导向性暴力行为。自我导向性暴力行为包括自杀行为和非自杀性自伤行为，可能导致严重的发病和死亡。本研究调查了因自伤就诊于美国创伤中心的患者的特征和结局，并确定了该患者群体中与存活至出院相关的因素。
我们以回顾性观察的方式从2020年国家创伤数据库（NTDB）中提取数据。NTDB包含来自900多家创伤中心的数据（占美国2294家创伤中心总数的900/2294，即39.2%）。我们对特征、损伤模式和结局进行了描述性分析。所有变量按结局（死亡：是/否）列表。然后，我们采用逐步技术进行多变量逻辑回归，以确定与患者存活至出院相关的因素。
本分析共纳入12824例自伤患者。他们的中位年龄为35岁（四分位间距25 - 50岁），大多数为男性（74.7%）且为白人（69.6%）。患者大多由地面救护车（78.9%）转运至一级（60.6%）和二级（33.5%）创伤中心。大多数患者有既往疾病（70.2%）。这些疾病包括精神/人格障碍（48.2%）、酒精使用障碍（11.5%）和物质使用障碍（17.7%）。最常见的损伤机制是穿透伤（71.6%），其次是钝器伤（18.0%）和烧伤（1%）。与火器相关创伤（40%）相比，切割/穿刺是最常见的穿透机制（60%）。32.8%的患者存在严重损伤（损伤严重度评分≥16）。分别有30.2%和31.2%的患者报告酒精筛查和/或药物筛查呈阳性。大多数患者入院治疗（86%）。出院时的总体死亡率为21.7%。我们确定了该患者群体中与存活至出院相关的重要因素。
在美国创伤中心接受治疗的自伤患者损伤严重程度高，死亡率也高。本研究揭示了这一脆弱患者群体所需的复杂且资源密集型护理。
