X. Doan1, S. Bagin1, C. H. Palacio1 1Valley Health System / McAllen Medical Center, Trauma, McAllen, TX, USA
Introduction:
In 2019 the United States had 3.96-gun related deaths per 100,000 people, placing the country at the 32nd-highest rate of deaths from gun violence in the world. Gun related mortality rate in the USA surpassed other developed countries. Currently, there is no literature that identifies injury patterns or weapon types used in suicides compared to homicides. This study hypothesizes that injury patterns, weapon type, and mortality differ between intentional self-harm (suicide group) as opposed to harm by others (homicide group).
Methods:
The National Trauma Database (NDTB) was queried from January 2017 to December 2019. All firearm related injuries were included, and weapon type was abstracted. Differences between homicide and intentional self-harm groups by sex, age, race, and injury severity were compared using a Mann-Whitney test for numerical data and Fisher’s exact test for categorical data. Logistic regressions were used to determine the ways that location and specifics of injury, and drugs in system were associated with intentional self-harm as opposed to harm by others. The association between weapon type and mortality relative to intentional self-harm as opposed to harm by others was assessed in Fisher’s exact tests. Significance was defined as p<0.05.
Results:
100,031 homicide and 11,714 suicide subjects met inclusion criteria, results in Table 1. Homicides were mostly assault victims (97.6%), male (88%), black (62%), more severe injury (ISS 20.73) and median age 20 years old (IQR 14 – 30), p<0.01. Suicides were mostly male (82%), white (79%), less severe injury (ISS 12.07), and median age of 36 years old (IQR 19 – 54), p<0.01. Handguns were used in 38% (24,961) of homicides vs 66% (5,246) of suicides, p<0.001 in Table 1. Suicide group had 7.9 and 1.8 higher odds of head/neck or face injuries abdominal or pelvic contents (OR=0.7), extremities or pelvic girdle (OR=0.4), or external areas (OR=0.4). The suicide group had greater odds of using antidepressant medications (barbiturates OR=3.9, benzodiazepines OR=2.3, tricyclines OR=2.7) than the homicide group, which had higher odds of recreational drug use (cocaine OR=0.8, ecstasy OR=0.3, opioids OR=0.8, phencyclidine OR=0.5, or cannabinoids OR=0.6. Mortality rate was higher for suicide group (44.8%; 95% confidence interval: 43.9%, 45.7%) compared to the homicide group (11.5%; 11.3%, 11.7%).
Conclusion:
Intentional self-harm had higher mortality, more severe injuries, and more head/neck/facial injuries than harm by others. Majority of suicides were with handguns. Both groups were predominantly male; however, suicides had higher anti-depressant use and majority white compared to higher recreational drug use and majority black in homicides.
