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Self-inflicted Abdominal Stab Wounds are Associated with a Higher Incidence of Non-Therapeutic Lapar
Kevin McKay, Nikolay Bugaev, MD, Janis L Breeze, MPH, Sandra S. Arabian, CSTR, Reuven Rabinovici, MD
Tufts Medical Center

Background: Current information on patients with self-inflicted abdominal stab wounds (SI-ASW) is limited due to the small number of cases studied. To better characterize these patients, the present study used a large sample extracted from the National Trauma Data Bank (NTDB).

Methods: Adult patients (>16 years old) with ASW were identified in the 2012 NTDB dataset. Demographics, co-morbidities, injury patterns, abdominal procedures, hospital course, and mortality were compared between the SI-ASW and non-self-inflicted (NSI-ASW) groups. Logistic regression modeling was used to find predictors of injuries in SI-ASW patients.

Results: Of 9,544 patients with ASW, 1,724 (18.1%) had SI-ASW. Male patients were prevalent in both groups, but SI-ASW patients had higher proportion of females (32.1% vs. 10.2%, p<0.0001). The SI-ASW group had more psychiatric illness (31.8% vs. 3.7%, p<0.001), alcohol (17.3% vs. 14%, p=0.0008) and drug abuse (10.1% vs.8.4%, p=0.0238). Importantly, SI-ASW patients had higher proportion of non-therapeutic laparotomies (23.0% vs 15.8%, p<0.0001), but a lower risk of abdominal injuries (42.6% vs.53.1%, p<0.0001). Mortality (1.1% in both groups) and morbidity (SI-ASW 26.6% vs NSI-ASW-25.5%, p= 0.36) did not differ between the two groups. Regression analysis identified male gender as the only predictor of injuries in SI-ASW patients (odds ratio 1.6; 95% confidence interval 1.3, 2.0).

Conclusion: Self-inflicted ASWs are associated with a higher incidence of non-therapeutic laparotomies and a lower risk of abdominal injuries. The high prevalence of preexisting psychiatric and alcohol/drug-related disorders may explain this observation. Given the above, the decision whether to operate on these patients could be challenging.

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