(182) Characterization of Clinical and Hospital Course of Suicide Attempts via Self-Inflicted Gunshot Wounds to the Head: A Retrospective Analysis at a Tertiary Care Academic Center

Background/Significance: Approximately 60% of individuals die from their first suicide attempt¹ of which 52.8% are from self-inflicted gunshot wounds², with the most common site of injury being the head³. Previous studies analyzed small sample sizes and included a broader range of patients with self inflicted gun shot wounds. This is the first study that focuses on patients with SIGSW to the head (SIGSW-H).  In this study, we investigate the sociodemographic, social, psychiatric, and clinical variables in a sample of survivors and non-survivors admitted to Atrium Health Wake Forest Baptist Hospital (AHWFBH), with a diagnosis of SIGSW-H.  Understanding how patients with SIGSW-H differ from the general population in terms of the variables analyzed in this study can further highlight better screening and prevention efforts.

Methods: This IRB-approved retrospective cohort study will phenotype individuals with head SIGSW-H (completers and non-completers) at AHWFBH. Data was extracted from the electronic health record using ICD codes W34.00XA (gunshot wound) from the years 2017-2023. Patients in this cohort are defined as having a documented gunshot wound diagnosis and suicide attempt. Variables of interest manually extracted include urine drug screen (UDS), serum ethanol level, psychiatric diagnoses, and preexisting substance use disorders. We hypothesize that survivors will have high levels of intoxication at presentation, prolonged hospitalization, tracheostomy/PEG as a barrier to inpatient psychiatric hospitalization, and a psychiatric diagnosis after presentation.

Results: Study is currently underway. Preliminary analysis of data extraction from 16 female and 83 male (99 total) SIGSW-H patients demonstrates 76% presented with acute intoxication based on urine drug screen of benzodiazepines, THC, opiates, and cocaine and 46% of patients presented with serum alcohol content greater than 100 ng/mL and 47% of patients had a tracheostomy and/or PEG tube present upon discharge. Nearly every patient had multiple psychiatric diagnoses after presentation.

Discussion: The preliminary findings provide valuable insight into the multifaceted nature of suicide, substance use, and SIGSW-H.  The high prevalence of substance use in the SIGSW-H patient population underscores the need for tailored interventions and preventive measures.

Conclusion/Implication: We propose clinicians incorporate questions about gun accessibility and gun safety in patients with significant substance use. Additionally, these patients have long length of stays complicated by tracheostomy/PEG tube. This makes their disposition complicated give lack of psychiatric beds with adequate medical capabilities. By examining the patterns in clinical characteristics, presentations, and complex hospital courses of patients with SIGSW-H, this study can help craft improved assessment and effective intervention strategies.  

References:
1. Bostwick JM, Pabbati C, Geske JR, et al: Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. American Journal of Psychiatry 173:1094–1100, 2016
2. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2020. https://www.cdc.gov/injury/wisqars/fatal.html. Accessed May 25, 2023 Google Scholar
3. Williams ST, Kores RC, Currier JM. Survivors of self-inflicted gunshot wounds: a 20-year chart review. Psychosomatics. 2011 Jan-Feb;52(1):34-40. doi: 10.1016/j.psym.2010.11.019. PMID: 21300193.

Presentation Eligibility: Not previously published or presented.

Diversity, Equity, and Inclusion: Understanding the social, psychiatric, and clinical variables in sample of patients who attempted suicide from gun shot wound to the head can help create better screening and prevention efforts. There are few studies that have investigated these variables but they were conducted in smaller sample sizes. When most of these patients are discharged from the hospital, they have to have a PEG tube or tracheostomy, which could further diminish their quality of life and mental well being.