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Clinical diagnostic phenotypes in hospitalizations due to self-inflicted firearm injury
Megan G Janeway1, Xiang Zhao2, Max Rosenthaler3
1Department of Surgery, Boston University Medical Center, Boston, MA, USA.
Insights
This study identified three distinct diagnostic phenotypes for self-inflicted firearm injuries. Understanding these patient clusters can help tailor clinical care and prevention strategies for firearm injuries.
Area of Science:
- Public Health
- Trauma Surgery
- Psychiatry
Background:
- Hospitalized self-inflicted firearm injuries are understudied, especially concerning clinical diagnoses.
- Identifying diagnostic phenotypes (DPs) is crucial for understanding these injuries.
Purpose of the Study:
- To discover diagnostic phenotypes (DPs) or clusters of hospitalized self-inflicted firearm injuries.
- To analyze clinical diagnoses associated with self-inflicted firearm injuries.
Main Methods:
- Utilized Nationwide Inpatient Sample data (1993-2014) in the US.
- Employed International Classification of Diseases, Ninth Revision (ICD-9) codes to identify injuries in adults.
- Applied hierarchical clustering to 25 frequent diagnostic codes to identify DPs.
Main Results:
- Identified three distinct DPs among 14,072 hospitalizations.
- DP1 (n=10,110) included major depressive disorder, hypertension, anemia, tobacco, and alcohol use.
- DP2 (n=3,725) included children and peripartum women; DP3 (n=237) had depression and fewer fatal chest/abdomen injuries.
Conclusions:
- Three distinct diagnostic phenotypes exist for self-inflicted firearm injuries.
- Further research is needed to apply DPs for tailored clinical care and prevention efforts.
- Claims data were used, representing a limitation of the study.
Background:
. Hospitalized self-inflicted firearm injuries have not been extensively studied, particularly regarding clinical diagnoses at the index admission. The objective of this study was to discover the diagnostic phenotypes (DPs) or clusters of hospitalized self-inflicted firearm injuries.
Methods:
. Using Nationwide Inpatient Sample data in the US from 1993 to 2014, we used International Classification of Diseases, Ninth Revision codes to identify self-inflicted firearm injuries among those ≥18 years of age. The 25 most frequent diagnostic codes were used to compute a dissimilarity matrix and the optimal number of clusters. We used hierarchical clustering to identify the main DPs.
Results:
. The overall cohort included 14072 hospitalizations, with self-inflicted firearm injuries occurring mainly in those between 16 to 45 years of age, black, with co-occurring tobacco and alcohol use, and mental illness. Out of the three identified DPs, DP1 was the largest (n=10,110), and included most common diagnoses similar to overall cohort, including major depressive disorders (27.7%), hypertension (16.8%), acute post hemorrhagic anemia (16.7%), tobacco (15.7%) and alcohol use (12.6%). DP2 (n=3,725) was not characterized by any of the top 25 ICD-9 diagnoses codes, and included children and peripartum women. DP3, the smallest phenotype (n=237), had high prevalence of depression similar to DP1, and defined by fewer fatal injuries of chest and abdomen.
Limitations:
. Claims data.
Conclusions:
. There were three distinct diagnostic phenotypes in hospitalizations due to self-inflicted firearm injuries. Further research is needed to determine how DPs can be used to tailor clinical care and prevention efforts.