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

Tu Q Nguyen, Pamela M Simpson, Sandra C Braaf, Belinda J Gabbe

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)184-194
Number of pages11
JournalInjury
Volume48
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017

Keywords

  • Deliberate self-harm
  • Functional
  • Return to work (RTW)
  • Trauma

Cite this

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title = "Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm",
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.",
keywords = "Deliberate self-harm, Functional, Return to work (RTW), Trauma",
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Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm. / Nguyen, Tu Q; Simpson, Pamela M; Braaf, Sandra C; Gabbe, Belinda J.

In: Injury, Vol. 48, No. 1, 01.01.2017, p. 184-194.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm

AU - Nguyen, Tu Q

AU - Simpson, Pamela M

AU - Braaf, Sandra C

AU - Gabbe, Belinda J

PY - 2017/1/1

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N2 - 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.

AB - 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.

KW - Deliberate self-harm

KW - Functional

KW - Return to work (RTW)

KW - Trauma

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