Elsevier

Injury

Volume 48, Issue 1, January 2017, Pages 184-194
Injury

Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm

https://doi.org/10.1016/j.injury.2016.10.038Get rights and content

Abstract

Background

Self-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.

Method

482 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.

Results

A 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).

Conclusion

The 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.

Introduction

Deliberate self-harm and intentional injury represent a significant public health concern. Self-harm is the second leading cause of death from injury, and together with road traffic crashes, account for the majority of the total burden of injury [1], [2]. But while the rate of unintentional injuries is projected to decrease, the incidence of intentional injuries is expected to rise significantly. The World Health Organisation (WHO) estimates that between 2002 and 2030, the global burden of self-inflicted injuries is expected to move up three places in the rank order of total DALYs worldwide [3].

Deliberate self-harm has been broadly defined as an act in which an individual deliberately inflicts harm upon themselves, but does not directly result in death [4]. The majority of self-harm cases survive [5], [6], [7], and examination of the outcomes of deliberate self-harm provides important insights into the burden of intentional injury. This can potentially inform clinical decision-making and health care planning for those injured by self-harm.

People who self-harm are at risk of further repeated self-harm and poor outcomes [8], [9], [10], [11], [12]. Their long-term outcomes, such as function and return to work, are largely unknown and have received very little research attention. The strongest evidence available are two birth cohort studies that suggested individuals who self-harm are subject to poor occupational outcomes and poor functioning [12], [13], however these studies provided evidence that was generalisable to self-harm in young people only. The outcomes of self-harm in a major trauma population have not previously been explored to the authors’ knowledge. The aims of this study were to describe the mortality, functional and return to work outcomes in the first two years after injury in a cohort of major trauma patients hospitalised for injuries resulting from deliberate self-harm.

Section snippets

Setting

The Victorian State Trauma Registry (VSTR) is a state-wide, population-based registry which captures information including demographics, cause and intent of injury, diagnoses and comorbidities of all hospitalised major trauma cases [14]. A case is included if any of the following criteria are met: (1) death after injury; (2) Injury Severity Score (ISS) > 12 based on the 2008 version of the Abbreviated Injury Scale; (3) admission to an Intensive Care Unit (ICU) for more than 24 h and requiring

Study population

There were 619 self-harm related major trauma patients captured by the VSTR during the study period. Of these, 482 (77.9%) individuals survived to hospital discharge. Most patients were male, belonged to the younger age groups and there was a high prevalence of psychiatric disorders, particularly mood disorders and alcohol use disorders (Table 1).

Responders vs non-responders

A responder was defined as a person who was successfully followed up i.e. had a valid GOS-E score at any of the follow-up time points. Overall,

Discussion

This study is one of the few studies, and to our knowledge the only population-based study, to describe functional and return to work outcomes of deliberate self-harm [23]. We have shown that most hospitalised self-harm major trauma patients who survived to discharge were alive two years post-injury. The proportion of post-discharge deaths (7.7%) was similar to that of the broader major trauma population (9.7%) [24]. In this cohort of self-harm patients, most were men and young to middle aged,

Conclusions

Overall, the majority of major trauma patients injured from deliberate self-harm who survived to hospital discharge were alive at two years post-injury. Two years following deliberate self-harm, two thirds of major trauma patients had not achieved a good recovery and almost half of patients had not returned to work. Older patients, patients with comorbidities and those who used transport-related methods were associated with poorer functional outcome. Patients with ISS > 24 were associated with

Conflict of interest

The authors report no conflicts of interest. No outside funding was received for this work.

Acknowledgements

The Victorian State Trauma Registry (VSTR) is funded by the Department of Health and Human Services, State Government of Victoria and the Transport Accident Commission. The funding source had no involvement in the preparation of the manuscript. Belinda Gabbe was supported by a National Health and Medical Research Council Career Development Fellowship (GNT1048731) during the preparation of this manuscript. The authors would like to acknowledge the project team: Mimi Morgan, Sue McLellan, Tani

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