Abstract
IntroductionIntentional self-harm (suicide) by firearms is a growing problem in the United States. Currently, there are no large studies that have identified risk factors for patients who die from self-inflicted gunshot wounds. Our objectives are to 1) identify risk factors for patients with the highest morbidity and mortality from self-inflicted gunshot wounds (SIGSWs) at trauma centers 2) present the outcomes of victims of SIGSW by handguns (HG) versus all other specified guns (AOG) and 3) compare the presentations and outcomes of victims with head or face (HF) injuries to other regions of the body.MethodsWe performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all SIGSW patients who presented to trauma centers. Categorical data included patient characteristics upon presentation and outcomes which were compared between patients with HG injury versus AOG injury using the Chi-Squared test, where AOG includes shotguns, hunting rifles, and military firearms. Additionally, analysis of head and face (HF) injuries versus other bodily injuries (OBI) were compared between the HG group versus AOG group using Chi-squared test.ResultsThere were 7,828 SIGSWs, of those, 78% (6,115) were white and 84.3% (6,600) were male. There were 5,139 HG injuries, 1,130 AOG injuries, and 1,405 unidentified gun injuries. The HG group was likely to be older (>55 years old), hypotensive (systolic blood pressure < 90), have a lower Glasgow Coma Score (GCS < 9), use illegal, or use prescription drugs. In comparing HF injuries (4,799) versus other bodily injuries (OBI) (3,028), HF group was more likely to use handguns, expire in ED, require ICU, and have a higher percent of overall mortality. Of the total OBI, the thorax, upper extremities, and abdomen were the most commonly injured.ConclusionIn our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms. SIGSWs in older white males with handguns are the most at-risk for severe complications. Future efforts should improve screening methods for handguns in suicidal patients and at developing prevention programs.
Highlights
Intentional self-harm by firearms is a growing problem in the United States
We performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all self-inflicted gunshot wounds (SIGSWs) patients who presented to trauma centers
In our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms
Summary
Intentional self-harm (suicide) by firearms is a growing problem in the United States. There are no large studies that have identified risk factors for patients who die from selfinflicted gunshot wounds. Intentional self-harm (suicide) is a growing problem in the United States (U.S.) and has recently become one of the top ten leading causes of death. For the purpose of our study, selfinflicted gunshot wound (SIGSW) is defined as a gunshot wound while the gun was in the possession of the injured person at the time of firing, with an unknown intent of the shooter. Assault by gunshot wound will be defined as when the gun was not in the possession of the injured person at the time of firing
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