C. M. Rajasingh1, L. Tennakoon1, K. L. Staudenmayer1 1Stanford University,Department Of Surgery,Palo Alto, CA, USA
Introduction: Self-inflicted gunshot wounds (SI-GSW) are often fatal, but those who survive get hospitalized for their injuries. What happens to these survivors after the initial hospitalization is not known. We hypothesized that patients who survive a SI-GSW are frequently readmitted. We also hypothesized that rates would be higher than those admitted for other mechanisms of deliberate self-harm (DSH).
Methods: This is a retrospective cohort analysis of hospital visits using the National Readmission Database (NRD) from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, 2013. The NRD is a new nationally representative sample of inpatient hospitalizations in the U.S. with an identifier that allows for linkage across hospitalizations. We included patients with any diagnosis indicating deliberate self-harm (DSH) as coded by International Statistical Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. This group was divided into those who had SI-GSW as their mechanism for self-harm and those who did not. In order to have 6-month follow-up data, we excluded patients discharged in the second half of the calendar year. Patients who did not survive their initial hospitalization were excluded. Weighted numbers are reported below.
Results: A total of 492 patients were admitted for SI-GSW between January and June 2013. The majority were male (N=396, 81%) and 34% (N=167) were ages 22-35. Of these patients, 156 (32%) experienced at least one readmission in 2013. The mean time to the first readmission was 72 days. The top three diagnosis group reasons for readmissions included Mental Health (31%), Injury or Poisoning (15%), and Musculoskeletal (11%). Readmissions for self-harm were low (<5%; small numbers not reportable per HCUP publishing restrictions). When compared to those admitted for DSH by non-firearm-related mechanisms, readmission rates were not statistically different (SI-GSW vs. other DSH 32% vs. 31%, p=0.70). However, readmissions for repeat self-harm were lower for the SI-GSW cohort (SI-GSW vs. other DSH <5% vs. 8%, p<0.001). In multivariate analysis controlling for patient and injury characteristics, SI-GSW was associated with a lower odds ratio for repeat self-harm admissions compared to other forms of DSH (OR 0.28, p=0.015).
Conclusion: Readmissions after survival for SI-GSW are frequent, indicating that estimates of the burden of survival can be underestimated if only focused on the initial hospitalization. To our knowledge, this is the first study to describe national readmission rates after SI-GSW. Furthermore, there are differences in readmission rates for SI-GSW vs. other forms of DSH. Overall readmission rates are the same for both groups, but the odds ratio for repeat self-harm admissions is 70% lower for the SI-GSW group even after controlling for severity of injury. This suggests opportunities for prevention and follow-up may differ between the two groups.