Self harm is an independent predictor of mortality in trauma and burns patients admitted to ICU

Patients with mental illness or depression may sustain self-inflicted injuries that require admission to an Intensive Care Unit (ICU). It is unknown whether the intent of injury leads to a greater likelihood of dying over and above the severity of the initial injury. Given the economic and societal burden of injury of self-harm, we designed this study to compare hospital outcomes of intentionally injured patients presenting to a tertiary ICU compared to unintentional injuries.

The regional trauma database was interrogated to produce two datasets that included all adult trauma patients admitted to the Alfred Intensive Care Unit between 01/07/2002 and 30/06/2007. The first included patients that sustained intentional injuries, the second comprised un-intentional injuries and acted as a control group. Logistic regression was used to model factors associated with mortality.

Intentionally injured patients made up 4.17% of the total burns, blunt and penetrating trauma admissions to the Alfred ICU over the five-year study period. There was a trend towards higher mortality overall and in all subgroups of patients with intentional injuries when compared to those with un-intentional mechanisms of injury. After adjusting for injury severity and age, a mechanism of injury involving intentional injury was independently associated with a doubling of the odds of death.

Our study is the first paper in the literature to describe an increased the risk of death within a group of patients admitted to a trauma and burns ICU following deliberate self-harm.