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Comments on the Article "Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions": To the Editor. Clin Orthop Surg 2024; 16:342-345. [PMID: 38562633 PMCID: PMC10973630 DOI: 10.4055/cios23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/12/2023] [Indexed: 04/04/2024] Open
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A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia. J Forensic Leg Med 2023; 97:102531. [PMID: 37210812 DOI: 10.1016/j.jflm.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. MATERIALS AND METHODS It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. RESULTS Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. CONCLUSIONS our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.
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[Suicide attempts with a violent method: Experience of a transdisciplinary psychiatric ward combining psychiatric and somatic care]. L'ENCEPHALE 2023; 49:158-164. [PMID: 35120752 DOI: 10.1016/j.encep.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Suicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries. METHODS We conducted a retrospective study including all subjects admitted into the transdisciplinary unit from 1st January 2011 to 31 December 2017, after a suicide attempt by jumping from a height, in front of a moving object, or by crashing of a motor vehicle. Data was obtained from the medical and administrative records of the clinic. RESULTS In total, 215 persons were admitted into the transdisciplinary unit after a suicide attempt by a violent mean. Among them, 91.6% had jumped from a height, 7.4% had jumped in front of a train or a metro and 0.9% had crashed a motor vehicle. They were on average 25.5years old and 50.2% were men. 45.1% had a diagnosis of schizophrenic disorders and 34.4% of mood disorders. A total of 35.6% presented at least one previous suicide attempt, and among them 40.3% had previously attempted suicide with a violent mean. Substance abuse, mostly alcohol and/or cannabis, featured in 40.8% of subject history. The subjects hospitalised in the transdisciplinary unit had multiple, severe injuries: 78.1% had spine fractures, 69.8% had lower limb fractures, 47.9% had pelvic fractures and 43.3% had upper limb fractures. Moreover, 25.5% of them had sacral root damages. The length of stay averaged 184days and varied in a large range (less than a month to more than two years). The Activities of Daily Living scores were higher than 3 (out of a maximum score of 4) reflecting an important need of assistance. These scores decreased significantly during the hospitalisation for dressing, feeding, continence and locomotion but remained high for comportment and communication. At discharge, the physical sequelae were still important: 61% of people hospitalised had pain that required step 2 or 3 analgesics, 44% had analgesics for neuropathic pain, 80% had lower limb impairments, most often with walking limitation, and 26% had continence disorders. The psychotropic treatments at discharge were related to the psychiatric disorders observed and included 42% antidepressants, 63% neuroleptics and 16% mood stabilizers. CONCLUSION This study highlights the severity of the somatic and psychiatric disorders affecting people who are admitted into this transdisciplinary unit. These subjects who have attempted suicide require particular care with multidisciplinary management in order to promote their rehabilitation, reintegration and prevent a suicide reattempt.
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Hospital inpatient suicides: A retrospective comparison between psychiatric and non-psychiatric inpatients in Milan healthcare facilities. Suicide Life Threat Behav 2023; 53:334-347. [PMID: 36748828 DOI: 10.1111/sltb.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/14/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Inpatient suicide in hospitals is a worrying phenomenon that has received little attention. This study retrospectively explored the socio-demographic, clinical, and suicide-related characteristics of hospital inpatient suicides in Milan, Italy, which were collected at the Institute of Forensic Medicine during a twenty-eight-year period (1993-2020). In particular, this study compared the features of hospital inpatient suicides in patients with and without psychiatric diagnoses. METHODS Data were collected through the historical archive, annual registers, and autopsy reports, in certified copies of the originals deposited with the prosecutors of the courts. RESULTS Considering the global sample, inpatients were mainly men (N = 128; 64.6%), with a mean age of 56.7 years (SD ± 19.8), of Italian nationality (N = 176; 88.9%), admitted to non-psychiatric wards (N = 132; 66.7%), with a single illness (N = 111; 56.1%), treated with psychotropic medications (N = 101; 51%), who used violent suicide methods (N = 177; 89.4%), died of organic injuries (N = 156; 78.8%), and outside the buildings (N = 114; 72.7%). Comparing psychiatric and non-psychiatric inpatients, suicide cases with a non-psychiatric diagnosis were predominantly men (N = 48; 76.2%), hospitalized in non-psychiatric wards (N = 62; 98.4%), assuming non-psychotropic drugs (N = 37; 58.7%), and died in outside hospital spaces (N = 54; 85.7%). CONCLUSIONS A fuller characterization of suicide among hospitalized inpatients requires systematic and computerized data gathering that provides for specific information. Indeed, this could be valuable for inpatient suicide prevention strategies as well as institutional policies.
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A comparative autopsy study of the injury distribution and severity between suicidal and accidental high falls. Forensic Sci Med Pathol 2022; 18:407-414. [PMID: 35771377 DOI: 10.1007/s12024-022-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Falls are the second cause of accidental deaths worldwide. Falls from height are also a common method of suicide. The aim of this study is to compare the characteristics of the victims, the circumstances of the fall and the severity and distribution of the injuries reported in an autopsy case series of falls from height. This study is a retrospective analysis of consecutive autopsy cases of suicidal and accidental falls from height which were investigated in the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period 2011-2019. The recorded variables included demographic data of the victim, height of fall, length of hospital stay, toxicological results, the existence and location of injuries and Injury Severity Score (ISS). Victims of suicidal falls were younger (55.53 vs. 62.98, p = 0.001), they fell from higher heights (12.35 vs. 5.18 m, p < 0.001), and they sustained more severe injuries compared with victims of accidental falls (ISS 51.01 vs. 40.88, p < 0.001). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequently observed after a suicidal fall (93.6% vs. 67.3%, 72.1% vs. 21.4%, 72.1% vs. 27.6%, 42.9% vs. 15.3%, 45.7% vs. 13.3%, respectively-p < 0.001), probably due to the higher height of fall. Our study outlines the differences in the profile of the victims and in the severity of injuries caused by falls from height depending on the intention of the victim to fall. However, a distinctive injury pattern in victims of suicidal falls was not demonstrated.
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Factors influencing the length of stay in a unit with mixed rehabilitation and psychiatric care after a suicide attempt by jumping: a cohort observational retrospective study. Eur J Phys Rehabil Med 2022; 58:749-756. [PMID: 36052890 PMCID: PMC10021286 DOI: 10.23736/s1973-9087.22.07341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Persons who have attempt suicide by jumping often require intensive treatment for their somatic injuries and the high risk of future completed suicide. The FSEF (French Student Health Foundation) developed a Transdisciplinary unit specifically designed for these people. AIM The aim of this study was to investigate psychiatric and somatic factors associated with Length Of Stay (LOS) in this unit. DESIGN Cohort observational retrospective study. SETTING The Transdisciplinary unit provide a dual approach, combining rehabilitation (physiotherapy, balneotherapy, occupational therapy, speech therapy, cognitive rehabilitation, social and family support) and psychiatric care. POPULATION Men and women admitted into the Transdisciplinary unit, after a suicide attempt by jumping from a height with severe somatic injuries. METHODS We examined the associations between potential predictors and LOS with Stepwise regressions: model 1 included all variables assessed at admission (age, sex, occupational status, psychiatric disorder history, height of the fall, type of injury, LOS in acute care units and dependences at admission); model 2: all variables at discharge (main psychiatric diagnosis, orientation at discharge, psychotropic treatments, pain treatments, arms mobility limitation, legs mobility limitation, sphincter disorders and dependences at discharge); final model: all significant variables in models 1 and 2. RESULTS One hundred ninety-seven subjects were included (49.7% of men; mean age: 25.6 years, ±6.21). Most factors associated with LOS were related to injuries due to the suicide attempt. LOS in the Transdisciplinary unit increased with longer LOS in acute care (β=0.589; P=0.003), higher dependence for continence at admission (β=44.640; P<0.001) and sphincter disorders at discharge (β=78.034; P<0.001). LOS was also longer with higher dependence for behavior at discharge (β=30.182; P=0.042) and unemployed status (β=59.496; P=0.008), which could reflect psychiatric disorders severity. LOS was shorter when subjects had arms mobility limitation at discharge (β=-42.591; P=0.018). CONCLUSIONS The persons admitted into this unit have serious physical injuries due to their fall. These injuries require intensive rehabilitation and their severity is the largest contributing factor to the LOS. Some findings also advocate for influence of psychiatric factors on LOS, underlying the need for both concomitant psychiatric and somatic care for these people. CLINICAL REHABILITATION IMPACT People should ideally receive both psychiatric and rehabilitation care after a suicide attempt by jumping.
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Five-year mortality after hospitalisation for suicide attempt with a violent method. J Psychosom Res 2022; 159:110949. [PMID: 35667157 DOI: 10.1016/j.jpsychores.2022.110949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to estimate the 5-year mortality among people admitted into a transdisciplinary unit providing combined psychiatric and somatic rehabilitation treatment. METHODS In this retrospective study, we analyzed the clinical records of all individuals admitted into the transdisciplinary unit from 01/01/2011 to 12/31/2017 after a suicide attempt using violent means. Vital status was ascertained for these 215 people, a standardized mortality ratio (SMR) was calculated and Log-rank tests were used to identify factors associated with mortality. RESULTS The crude mortality rate was 5.12% (11 deaths) and the SMR was 15.45 (95% CI = [7.71-27.65]; p < 0.001) 5.40 years after admission into the transdisciplinary unit. Factors associated with mortality were: older age (29.91 years versus 25.30 years, p < 0.001), a longer stay in acute care (p = 0.002) and a shorter stay in the transdisciplinary unit (p < 0.001). CONCLUSION Long-term mortality among people who have attempted suicide using violent means is 15 times higher than in the corresponding general young adult population. This study supports the hypothesis that the severity of a suicide attempt is associated with subsequent excess mortality. Therefore, there is a need to consolidate outpatient facilities that provide appropriate support for this specific population after discharge. These programmes need to ensure the continuity of coordinated psychiatric and somatic care and psychosocial rehabilitation in order to prevent the risk of suicide.
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Psychiatric and physical rehabilitation intensive approach for suicide attempters by jumping from heights. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021433. [PMID: 34747385 PMCID: PMC10523033 DOI: 10.23750/abm.v92is1.11454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022]
Abstract
Suicide is an important public health problem and one of the leading causes of death worldwide. Suicide behavior is influenced by interacting biological, psychological, environmental and current situational factors. One of the most important components modulating the risk of suicide as well his prevention is mental health: it is estimated that up to 90% of individuals who attempt suicide meets the criteria for a psychiatric disorder. Multiple other factors, such as physical illness, can be related to suicidal behaviors. Medical disorders may themselves be associated with an increased risk of suicide or be consequence of violent suicide attempts such as jumping from height. Providing optimal treatment for patients with suicidal behaviors, especially if violent, involves multiple treatments that may include psychiatric, psychological and physical therapies. Using a case series approach, we describe an acute psychiatric treatment program combined with intensive rehabilitation therapy in patients hospitalized for violent suicide attempts caused by jumping from height. The patients were treated through a multidisciplinary, simultaneous and integrated care program made up of a team of psychiatrists and physiatrists who work dynamically together with a flexible approach based on the specific clinical characteristics of each patient.
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An analysis of the impact of suicide prevention messages and memorials on motorway bridges. Suicide Life Threat Behav 2021; 51:657-664. [PMID: 33576544 DOI: 10.1111/sltb.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
Recently, there has been activity at public locations where people have died by suicide, including the erection of suicide prevention messages and memorials (decorations). This research looks at the impact of these decorations and associated media coverage of the decorations on suicidal behaviour at bridges. Incidents (n = 160) of suicidal behaviour on 26 bridges across motorways in England were analysed. Overall, there was no significant difference in the proportion of incidents pre-decoration versus post-decoration (p-value = .55). The incident rates were not significantly different pre- and post-decoration (p = .46). Only one bridge had statistically significantly more incidents post-decoration and media reporting (p = .03). However, following correction for multiple testing there was no significant difference in pre- and post-incident rates at any of the bridges. In total, 58% of bridges had a greater frequency of incidents when decorations were absent; however, this proportion was not statistically significant (p = .41). Further research is required to establish how suicide prevention messages are perceived. There does not appear to be any benefit, but it often generates media coverage which has been shown to increase risk.
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Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience. Eur J Trauma Emerg Surg 2020; 48:915-920. [PMID: 32936309 DOI: 10.1007/s00068-020-01499-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Suicide is a common cause of death in Brazil, with an overall increase of 62.5% during the last 30-year period. The study aims to determine overall patient characteristics and symptomatic indicators of complications among survivors. METHODS In this retrospective cross-sectional study, we collected and analyzed clinical information of all patients aged > 10 years who presented to our hospital with a history of attempted suicide by jumping from a height in a 7-year period. Records were searched for primary demographic data, radiographs and CT scans were reviewed to determine injury characteristics, and records and operative notes were searched to look for symptomatic indicators of complications among survivors. Baseline demographics and the distribution on skeletal injuries were compared between the survivor and non-survivor patients using the Chi-squared for categorical variables and the Student's t-test for continuous variables. Among survivors, univariate and multivariate analysis were performed to investigate independent risk factors of attempted suicide and complications. RESULTS A total of 222 patients attempted suicide by jumping from a height. At multivariate analysis, the middle-aged patient was the unique identified risk factor for suicide by jumping from a height. Overall mortality was 67.6%. The main independent cause for death was traumatic brain injury. Among survivors, there was a higher incidence of foot and ankle fractures, and pelvic ring injuries. The overall complication rate for survivor patients was 51.4%, with acute infection being the most prevalent complication. At multivariate analysis, middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures were identified as risk factors for acute complications. CONCLUSION Middle-aged people are at significant risk for attempting suicide by jumping from a height in Brazil, independently of gender, with 67.6% deaths. Traumatic brain injury, higher ISS, and more than 3 skeletal injuries are independent variables related to this fatal outcome. Acute complications occur in approximately 50% of survivors. Middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures are risk factors for complications.
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Falls from height: orthopaedic and psychiatric evaluation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:79-84. [PMID: 32555080 PMCID: PMC7944834 DOI: 10.23750/abm.v91i4-s.9366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fall from a height is one of the major causes of significant trauma with high morbidity and mortality rates. Traumatological damage control is often the primary treatment both for suicide attempt survivors and for accidental fall victims, but management of the hospitalization of psychiatric patients requires more resources than other patients. METHODS Retrospective multidisciplinary study (psychiatric and orthopaedic evaluation) and analysis of psychiatric and trauma characteristics of patients fallen from height admitted to our trauma centre. We analysed patterns of patients after suicidal jumps and accidental falls to look for possible trends that may trigger projects for further improvement of care. RESULTS 205 patients were analysed, 137 were included: 65 suicide attempt survivors and 72 accidental fall victims. Between these two groups there are no differences about the anaesthesiologic acute management or the number of damage control procedures. However, the psychiatric patients stay longer in hospital especially in intensive care unit with prolonged intubation (p<0.001). Suicide attempt survivors are significant correlated with fractures of feet, but the orthopaedic lesions do not involve an increase of definitive interventions (p< 0.05). CONCLUSION We showed that the suicide attempt survivors and accidental victims need the same acute management. The orthopedic definitive surgical procedures are similar between the two groups, but in spite of this patients with psychiatric disorder were associated with a statistically significant increase of care in intensive care unit and hospitalization. Our results allow to create a new multidisciplinary approach for these patients.
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Suicide attempts by jumping and length of stay in general hospital: A retrospective study of 225 patients. J Psychosom Res 2019; 119:34-41. [PMID: 30947815 DOI: 10.1016/j.jpsychores.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Violent suicide attempts, such as jumping from a height, frequently lead to hospitalization in general hospital with high length of stay (LOS). We investigated features associated with LOS in this context. METHODS We retrospectively included all patients admitted after suicide attempts by jumping in non-psychiatric wards of a university hospital between 2008 and 2016. Several socio-demographic and clinical data were collected, including psychiatric diagnoses, coded with the International Classification of Diseases-10th Revision. We used general linear models to identify factors associated with LOS. RESULTS Among 225 patients (125 men; mean age ± sd: 37.5 ± 15.4 years), several clinical factors were independently associated with a longer LOS: number of injuries (β = 8.2 p < .001), external fixator (β = 18.1 p = .01), psychotic disorder (β = 14.6 p = .02) and delirium (β = 16.6 p = .005). Admission in psychiatric ward at discharge tended to be associated with lower LOS (β = -15.3 p = .07). CONCLUSION In patients admitted in non-psychiatric wards after suicide attempt by jumping, the presence of a psychotic disorder may increase LOS by several days, and indirectly costs of hospitalization, to a similar extent of non-psychiatric factors. The association of transfer in psychiatric ward with lower LOS suggests that the psychiatric disorder might interfere with medical care.
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Abstract
Background Missed or underestimated injuries are one of the central problems in trauma care. Foot injuries can easily be missed because they lay beyond the regularly screened field of a trauma computer tomography scan (CT scan). During primary and secondary survey a careful examination of the extremities often becomes of secondary interest in the severely injured patient. Methods Thirty-four thousand ninety-one multiple trauma patients of the TraumaRegister DGU® were evaluated from 2002 to 2014. We differentiated between patients with foot injuries, patients with missed foot injuries and patients without foot injuries. Included were ankle fractures, calcaneus fractures, talus fractures, metatarsal fractures, toe fractures, amputation, soft tissue injuries and/or ligamentous injuries. Results Summarized evaluation of 34,091 trauma patients showed a share of 2532 patients with foot injuries. Time of diagnosis was documented in 2199 cases. 2055 patients had early diagnosed foot injuries and 144 patients had initially missed foot injuries. Missed foot injuries were especially found in patients with car accidents or fall from ≥3 m. Patients with higher Abbreviated Injury Scale (AIS) or lower Glasgow Coma Scale (GCS) were not significantly more affected by missed foot injuries. Missing foot injuries was also not caused by injury severity or higher age. Conclusions Our data highlights the need of careful evaluation of the feet during primary and secondary survey particularly when a tibia or femur fracture is diagnosed. Special attention should be turned to patients after car accidents or fall from great height. Suicide victims also need major attention. Patients with early operations also need careful examination and tertiary survey is highly recommended.
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Suicidal fall from heights trauma: difficult management and poor results. Eur J Trauma Emerg Surg 2019; 46:383-388. [PMID: 30840092 DOI: 10.1007/s00068-019-01110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients. MATERIALS AND METHODS The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared. RESULTS The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008). CONCLUSIONS In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to "feet-first landing" and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients.
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Abstract
STUDY DESIGN This was a retrospective case series at a single institution. OBJECTIVE The study was performed to investigate the characteristics of spinal injuries in survivors of suicidal jumping. SUMMARY OF BACKGROUND DATA Spinal fracture/dislocation is associated with high-energy trauma such as that induced by motor vehicle accidents. Survivors of suicidal jumping sometimes sustain spinal injuries. However, the characteristics of such spinal injuries are unclear. METHODS We identified 87 survivors of suicidal jumping who sustained spinal injuries from 2007 to 2016 in our institution. We compared the demographic data, radiological findings, neurological status, associated injuries, treatments, and mental health conditions between these 87 survivors and 204 non-suicidal patients with spinal injury. RESULTS Suicidal jumpers were predominantly female (67%) and 10 years younger than non-suicidal patients. Mental health problems, mainly schizophrenia and depression, were diagnosed in 77% of suicidal jumpers. Neurological damage from spinal trauma was generally less severe in suicidal jumpers than in non-suicidal patients. Most spinal injuries in suicidal jumpers were located in the thoracic or lumbar spine region (85%). Among comorbid injuries, extremity injuries were highly associated with spine injury in suicidal jumpers. Nearly 70% of suicidal jumpers exhibited extremity injury in contrast to 33% of non-suicidal patients. Approximately, 25% of suicidal jumpers underwent surgical treatment. Surgical treatment was similarly performed on suicidal jumpers and non-suicidal patients regardless of the discrepancy in neurological damage between these two groups. CONCLUSION Spinal injuries in suicidal jumpers differed from spinal injuries in non-suicidal patients with regard to sex, age, mental health condition, injury location, neurologic damage, and associated injuries. Most survivors of suicidal jumping were young female patients with mental health problems. They tended to have thoracic and lumbar spine trauma rather than cervical trauma with less severe neurological deficits and a higher incidence of accompanying limb injury. LEVEL OF EVIDENCE 3.
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Factors associated with autopsy rates in a 6-year sample of Danish suicides in the Capital area of Copenhagen. J Forensic Leg Med 2018; 60:50-55. [PMID: 30312875 DOI: 10.1016/j.jflm.2018.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/17/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
On average, two suicides occur in Denmark every day. In order to prevent suicides, it is important to understand their nature. The forensic autopsy plays an important role by providing detailed knowledge of the cause and manner of death. Unfortunately, the autopsy rate for suicides in Denmark is very low. The aim of this study was to elucidate the factors that may affect the decision to perform a forensic autopsy and thereby affect the autopsy rate of suicidal deaths in the Capital area of Copenhagen. Data from 6211 death certificates from the Capital area of Copenhagen, Denmark, over a study period of six years, were investigated. For deaths classified as suicide, the presence of the following factors were registered: gender, age, date of birth, date of death, marital status, nationality, place of death, cause of death, psychiatric condition, former admissions at a psychiatric ward, former attempts of suicide, presence of suicide note, history of substance abuse (alcohol, narcotics or both), and presence of self-inflicted scars. These factors were cross-tabulated with whether a referral to a forensic autopsy was made. Significant association was calculated by using Chi2 and Fisher's exact test. We found a total of 381 cases of suicide. The forensic autopsy rate was 21.3%. The following factors were associated with a significantly lower forensic autopsy rate: age above 50, history of psychiatric illness, the presence of a suicide letter, and cause of death registered as hanging/strangulation/suffocation, drowning/submersion, self-harm with sharp object, and jumping from height. Only the presence of a suicide letter remained significant after the Bonferroni correction for multiple testing. History of substance abuse and cause of death registered as intentional exposure to smoke, fire and flames were associated with a significantly higher forensic autopsy rate. A forensic autopsy can give more precise information on suicide methods, the impact of fatal lesions and comorbidity. Our study results showed that violent methods of suicidal death and psychiatric comorbidity led to a lower forensic autopsy rate. A higher autopsy rate would enable more thorough study and investigation of suicides, which would benefit the next-of-kin, general preventive procedures, and treatment of patients at risk of suicide.
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Patients admitted to hospital after suicide attempt with violent methods compared to patients with deliberate self-poisoning -a study of background variables, somatic and psychiatric health and suicidal behavior. BMC Psychiatry 2018; 18:21. [PMID: 29368645 PMCID: PMC5784599 DOI: 10.1186/s12888-018-1602-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In Norway, there are about 550 suicides recorded each year. The number of suicide attempts is 10-15 times higher. Suicide attempt is a major risk factor for suicide, in particular when violent methods are used. Suicide attempts with violent methods have hardly been studied in Norway. This study describes demographic, psychiatric and somatic health in patients admitted to somatic hospitals in Norway after suicide attempt by violent methods compared with suicide attempters using deliberate self-poisoning (DSP). METHODS Patients admitted to somatic hospital after suicide attempt aged > 18 years were included in a prospective cohort study, enrolled from December 2010 to April 2015. Demographics (gender, age, marital and living condition, educational and employment status), previous somatic and psychological health were registered. Patients who had used violent methods were compared with patients admitted after suicide attempt by DSP. RESULTS The study included 80 patients with violent methods and 81 patients with DSP (mean age both groups 42 yrs.). Violent methods used were cutting (34%), jumping from heights (32%), hanging (14%), others (10%), shooting (7%) and drowning (4%). Patients with violent methods had more often psychosis than patients admitted with DSP (14% vs 4%, p < 0.05), less anxiety disorders (4% vs 19%, p < 0.01) and less affective disorders (21% vs. 36%, p < 0.05). There were no significant differences between the numbers of patients who received psychiatric treatment at the time of the suicide attempt (violent 55% versus DSP 48%) or reported previous suicide attempt, 58% in patients with violent methods and 47% in DSP. Patients with violent methods stayed longer in hospital (14.3 (mean 8.3-20.3) vs. 2.3 (mean 1.6-3.1) days, p < 0.001), stayed longer in intensive care unit (5 days vs. 0.5 days, p < 0.001) and were in need of longer mechanical ventilation (1.4 vs 0.1 days, p < 0.001). CONCLUSIONS Patients with violent methods had more often psychosis, less anxiety disorders and affective disorders than patients with DSP. Psychiatric treatment before the attempt and previous suicide attempt was not significantly different between the groups and about half of the patients in both groups were in psychiatric treatment at the time of the suicide attempt.
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