Suicide versus homicide firearm injury patterns on trauma systems in a study of the National Trauma Data Bank (NTDB)

Abstract

Firearm related mortality in the USA surpassed all other developed countries. This study hypothesizes that injury patterns, weapon type, and mortality differ between suicide groups as opposed to homicide. The American College of Surgeons National Trauma Database was queried from January 2017 to December 2019. All firearm related injuries were included, and weapon type was abstracted. Differences between homicide and suicide groups by sex, age, race, and injury severity were compared using a Mann–Whitney test for numerical data and Fisher’s exact test for categorical data. The association between weapon type and mortality relative to suicide as opposed to homicide was assessed in Fisher’s exact tests. Significance was defined as p < 0.05. There were 100,031 homicide and 11,714 suicide subjects that met inclusion criteria. Homicides were mostly assault victims (97.6%), male (88%), African–American (62%), had less severe injury (mean (ISS) 12.07) and a median age of 20 years old (IQR: 14, 30, p < 0.01). Suicides were mostly male (83%), white (79%), had more severe injury (mean ISS 20.73), and a median age of 36 years old (IQR: 19, 54, p < 0.01). Suicide group had higher odds of head/neck (OR = 13.6) or face (OR = 5.7) injuries, with lower odds of injury to chest (OR = 0.55), abdominal or pelvic contents (OR = 0.25), extremities or pelvic girdle (OR = 0.15), or superficial soft tissue (OR = 0.32). Mortality rate was higher for suicide group (44.8%; 95% confidence interval (CI) 43.9%, 45.7%) compared to the homicide group (11.5%; 95% CI 11.3%, 11.7%). Suicide had higher mortality, more severe injuries, and more head/neck/facial injuries than homicide. Majority of suicides were with handguns.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

“…This study found that firearms were the most likely mechanism [ 19 ]. Other trauma investigators have reported similarly high injury severity and mortality rates with self-inflicted trauma than other intentions [ 41 – 43 ].…”

“…Our findings that used the same data source as Truong et al, comport with these findings of high mortality [ 40 ]. General trauma literature has similarly found higher severity indices and mortality for firearms injury [ 41 , 42 ] and a propensity for self-inflicted firearms injuries to involve the head and face [ 41 , 43 ]. A recent study used CDC data and heat maps from 1990 to 2021 to evaluate trends in demographic and regional disparities in firearms-related mortality [ 44 ].…”

A decade of firearm injuries: Have we improved?

“…However, this trend was no longer apparent after adjustment. Given the low survivability associated with many self-inflicted firearm injuries, 39 this finding may be more reflective of the increasing incidence of these injuries rather than overall trauma center performance. 40,41 The present study did not demonstrate an increase in self-inflicted injuries over time, but given the increased likelihood of death on scene, the data likely does not reflect the totality of these injuries.…”

Mechanisms of traumatic injury by demographic characteristics: an 8-year review of temporal trends from the National Trauma Data Bank

“…The highest rates of firearm mortality have been reported among non-Hispanic Black patients 27. Intent for firearm injuries has also differed, where self-inflicted firearm injuries are more common in older white men and assault-related firearm injuries were more common in younger, non-Hispanic Black individuals compared with Hispanic or non-Hispanic White individuals 27 28. Firearm violence is also influenced by geospatial patterns, including neighbourhood characteristics and social networks 29–31.…”