Mortality,functional and return to work outcomes of major trauma patients injured from deliberate self-harm |
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| Affiliation: | 1. Monash University, Department of Epidemiology and Preventive Medicine, The Alfred Centre, 99 Commercial Road Melbourne VIC 3004, Australia;2. Farr Institute at the Centre for Improvement in Population Health through E-records Research (CIPHER), Swansea University Medical School, Swansea University, United Kingdom;1. CHU de Québec – Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma − Emergency – Critical Care Medicine, Université Laval, Québec (QC), Canada;2. Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada;3. Institut National d''Excellence en Santé et en Services Sociaux, Montréal, Québec, Canada;4. Department of Neurological Sciences, Division of Neurosurgery, Université Laval, Québec (QC), Canada;5. Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec (QC), Canada;1. French Military Medical Service, Medical Center of Solenzara air base, BA 126 RN 198 Cs 10001 Ventiseri 20223 Ghisonaccia Cedex, France;2. French Military Medical Service, 7th paratrooper forward surgical unit, Laveran Military teaching hospital, general surgery unit, Marseille France;3. French Military Medical Service, 7th paratrooper forward surgical unit, Sainte-Anne Military teaching hospital, orthopedic surgery unit, Toulon France;4. French Military Medical Service, French Military Center for Epidemiology and Public Health, France;5. French Military Medical Service, Medical Center of Luxeuil air base, France;6. French Military Medical Service, Medical Center of Angers, France;7. French Military Medical Service, Medical Center of Mont-de-Marsan air base, France;8. French Military Medical Service, Medical Center of Lyon, France;9. French Military Medical Service, French Military Medical Service Academy – École du Val-de-Grâce, France;10. French Military Medical Service, Operational headquarters, M3 Current operations officer, France;11. French Military Medical Service, 7th paratrooper forward surgical unit, Sainte-Anne Military teaching hospital, intensive care and anaesthesiology unit, Toulon, France;1. Department of Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan;2. Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;1. Swedish Medical Centre, Trauma Research Department, Englewood, CO, USA;2. St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA;3. The Medical Centre of Plano, Plano, TX, USA;4. Penrose Hospital, Colorado Springs, CO, USA;5. Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA;1. Department of Anaesthetics and Critical Care, Perioperative Research Group, University of KwaZulu-Natal, South Africa;2. Department of Surgery, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, South Africa;3. University of KwaZulu-Natal Trauma Surgery Training Unit, Deputy Director: IALCH Trauma Service and Trauma ICU, KwaZulu-Natal Department of Health, South Africa;4. Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa |
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| Abstract: | BackgroundSelf-harm and intentional injuries represent a significant public health concern. People who survive serious injury from self-harm can experience poor outcomes that negatively impact on their daily life. The aim of this study was to investigate a cohort of major trauma patients hospitalised for self-harm in Victoria, and to identify risk factors for longer term mortality, functional recovery and return to work.Method482 adult major trauma patients who were injured due to self-harm and survived to hospital discharge, and were captured by the population-based Victorian State Trauma Registry (VSTR), were included. For those with a date of injury from January 1, 2007 to December 31, 2013, demographics and injury event data, Glasgow Outcome Scale Extended (GOS-E) and return to work (RTW) outcomes at 6, 12 and 24 months post-injury were extracted from the registry. Post-discharge mortality was identified through the Victorian Registry of Births, Deaths and Marriages (BDM). Multivariable logistic regression was used to determine predictors of the GOS-E and RTW and survival analysis was used to identify predictors of mortality.ResultsA total of 37 (7.7%) deaths occurred post-discharge. There were no clear predictors of all-cause mortality. Overall, 36% of patients reported making a good recovery at 24 months. Older age (p = 0.01), transport-related methods of self-harm (p = 0.02), higher Injury Severity Score (p < 0.001) and having a Charlson Comorbidity Index weighting of one or more (p = 0.02) were predictive of poorer functional recovery. Of patients who were working or studying prior to injury, 54% reported returning to work by 24 months post-injury. Higher Injury Severity Score was an important predictor of not returning to work (p = 0.002).ConclusionThe vast majority of major trauma patients who self-harmed and survived to hospital discharge were alive at two years post-injury, yet only half of this cohort returned to work and just over a third of patients experienced a good recovery. |
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| Keywords: | Deliberate self-harm Trauma Functional Return to work (RTW) |
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