Factors affecting survival following self-inflicted head and neck gunshot wounds: a single-centre retrospective review

• Published in: International journal of oral and maxillofacial surgery 2016-04, Vol.45 (4), p.513-516
• Main Authors: Murphy, J.A, Lee, M.T, Liu, X, Warburton, G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Craniocerebral Trauma - surgery; Dentistry; Female; gunshot; head and neck; Humans; Male; Middle Aged; Neck Injuries - surgery; Retrospective Studies; suicide; Suicide, Attempted; Surgery; Survival Rate; Wounds, Gunshot - surgery
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2015.10.004

Abstract Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records ( n = 157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the χ2 test or Fisher's exact test for statistical difference testing. Outcomes recorded were death ( n = 92, 59%), discharge to long-term care/rehabilitation ( n = 58, 37%), and discharge home ( n = 7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system ( n = 127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury ( P = 0.025). A tracheostomy within 24 h of admission was statistically associated with improved survival ( P < 0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.