E. Wagreich1, S. Armen1, J. Chandler1, R. Staszak1, K. Fitzgerald1, S. Allen1 1Penn State Hershey Medical Center,Hershey, PA, USA
Introduction: Suicide represents over 60% of all violent deaths annually, with a significant number of attempts being unsuccessful. The cost of self-inflicted violent injury related to suicide attempts is not well studied to know the impact these injuries have on the modern healthcare system. We hypothesized that self-inflicted injuries from failed suicide attempts represent a unique demographic pattern with a significant burden on the current healthcare system as evidenced by longer hospital stays.
Methods: The institutional trauma registry from an academic level 1 trauma center was queried over a 5-year period. Institutional Review Board approval was obtained prior to initiation of the study. Those patients (>18 years of age) who sustained self-inflicted (SI) penetrating injuries to the head, chest and abdomen were included in the study and matched by injury pattern and injury severity score (ISS) to a separate cohort of subjects who sustained penetrating injuries from non-self inflicted (NSI) violent injury. Variables studied included age, gender, race, ISS, whether a psychiatric consult was obtained, hospital length of stay (LOS) and discharge destination.
Results: Those who suffered SI (n=120) wounds were significantly older (46.0 years) than those from NSI (n=200) injuries (mean 32.5 years), P<0.001. Nearly 85% of those injured were male in both groups. There were significant racial differences among the SI and NSI groups (SI: 10% black, 84% Caucasian, 6% other vs. NSI: 47.4% black, 37.2% Caucasian and 15.4% other, P<0.05). The mechanisms of injury were evenly split between gunshot wounds (GSW) (51%) vs. stab wounds (SW) (49%), P=ns. Female SI injuries were most often due to stab wounds (64.7%) while men sustained more firearm injuries (57.3%) in the SI group, although this difference was not statistically significant. Mortality was significantly higher in those with SI wounds (30.8%) vs. those with NSI injuries (9.5%), P<0.001; with the majority of those deaths within the first 24 hours. Within the SI group, those discharged home had a significantly longer stay (12.1 days) than those discharged to another facility (5.8 days), P = 0.02; with the vast majority discharged to a psychiatric facility (65.1%). Discharge to psychiatric facilities was often delayed or prevented altogether due to management of open wounds, presence of surgical staples and surgical drains. There were no differences in overall LOS between SI and NSI groups (8.1 days vs. 8.2 days, P=ns).
Conclusion:SI injuries for those who survive suicide attempts represent a unique challenge to the healthcare system due to relatively long hospital stays. Inpatient psychiatric care may be delayed or even prevented due to placement difficulties from the presence of surgical drains or closure techniques. These patients may no longer meet criteria required for inpatient psychiatric care thus not allowing them to receive the definitive psychiatric care they require. Techniques as simple as wound closure with sutures rather than staples and even delayed primary closure of open wounds may prevent unnecessary delays to definitive psychiatric care. Further inquiry of institutional practices across hospitals, and encouragement of communication between psychiatric and non-psychiatric units may yield valuable information by which to guide future practice.