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Differences In Pediatric And Adult Methods Of Suicide And Self-inflicted Injury At A Rural Level 1 Pediatric Trauma Center
Jacob Hartman-Kenzler1, Mark Hamill1, Dan Freeman2, Sarah Parker2, Tanya Trevilian2, *Shawn Safford1
1Virginia Tech Carilion School of Medicine, Roanoke, VA;2Carilion Clinic, Roanoke, VA

Background
Suicide and self-inflicted injury (SII) are a leading cause of death across the U.S., and the second leading cause of death in 10-18 year-olds. There is a limited understanding of methods of injury and demographics for pediatric cases as they compare to adults, which leads to differences in treatment approaches. We have analyzed a large, multi-year trauma database to determine the difference in methods of SII between adult and pediatric patients at a rural level 1 trauma center.   
Methods
The database included patients admitted to a rural level 1 trauma center for suicide and SII from 2005-2018. We compared pediatric (<18yo) and adult patients based on SII E-Codes (E950-959) using Chi-squared analysis and a p-value <0.05 as significant.
Results
Pediatric patients were significantly more likely than adults to intentionally injure themselves via hanging (24% vs. 8.5%, p<0.01) or jumping (19% vs. 9.1%, p<0.05).  No other significant differences were identified (Table 1).
Table 1. Patients admitted under E-codes 950-959

<18yo (n=37)>=18yo (n=696)DifferenceChi-Sq p-value
GSW27.0%40.2%13.2%0.110
Hanging24.3%8.48%15.8%0.0012
Cut/Stab21.6%29.5%7.8%0.307
Jumping18.9%9.05%9.87%0.0467
Other8.20%12.8%4.60%0.4111

Conclusion
Our analysis demonstrates significant differences between adult and pediatric methods of SII with higher incidence of hanging and jumping mechanisms in children. These results are also in contrast to recently published national data that show cut/stabbing as the leading mechanism in pediatric SII. These data, along with increasing incidence nationally, suggest pediatric SII may require different approaches to treatment and prevention.


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