Self-inflicted abdominal stab wounds

doi:10.1016/S0020-1383(02)00084-0

Injury

Volume 34, Issue 1, January 2003, Pages 35-39

https://doi.org/10.1016/S0020-1383(02)00084-0 Get rights and content

Abstract

Background: Self-inflicted abdominal stab wounds (ASWs) are uncommon. The present study aims to characterize the clinical profile of this unique group of psychiatric–surgical patients. Methods: A retrospective review of 23 patients with intentional self-inflicted ASWs at two urban level I trauma centres during a 10-year period. Results: Most patients were males (70%), ages ranging from 21 to 82 years (mean 40 years). Seventy-four percent of patients had a previous psychiatric history and prior suicide attempts were common (41%). Half of the patients had a positive admission drug or alcohol screen. Hypotension (systolic blood pressure (SBP) <90 mmHg) was present in only two patients. Mean injury severity, revised trauma and Glasgow coma scores were 5.8, 7.7 and 14.5, respectively. The most commonly used instrument was a knife (87%). There were 1.5 external wounds per patient located primarily in the right upper quadrant (40%) and right lower quadrant (23%). These were associated with extra-abdominal wounds in 22% of cases. Local wound exploration was positive in 15 patients (65%), who all underwent laparotomy. Injured intra-abdominal or retroperitoneal organs were identified in 10 patients and included the stomach, duodenum, small bowel, colon, mesentery, inferior vena cava (IVC) and psoas muscle with a mean of 1.7 injuries per patient. Wound infection was the only post-operative complication (two patients). All eight patients with a negative local wound exploration were observed without complication. Seventy percent of patients were ultimately transferred to a psychiatric ward with a mean length of stay on the surgical service of 8 days. Only one patient died during admission due to metastatic malignant disease. Conclusion: Self-inflicted ASWs in suicidal patients can induce significant although most likely non-lethal abdominal and retroperitoneal injuries. This observation should guide the trauma surgeon when treating such patients.

Introduction

Suicide is the ninth leading cause of death in the US with more than 30,000 annual fatalities [1]. Self-inflicted abdominal stab wounds (ASWs) account for a very small fraction of these victims. Furthermore, the few reported series of suicide by self-stabbing which are all derived from forensic and psychiatric literature provide only limited trauma-related clinical information [2], [3], [4], [5], [6], [7]. The present retrospective review of 23 cases of self-inflicted ASWs from two level I trauma centres aimed to comprehensively characterize the clinical profile of this uncommon group of patients.

Section snippets

Methods

This retrospective study includes cases admitted during a 10-year period to two urban level I trauma centres (Thomas Jefferson University Hospital in Philadelphia, PA and Yale-New Haven Hospital (YNHH) in New Haven, CT). These institutions provide care to both inner city and suburban populations. The Jefferson trauma service is one of five level I trauma centres that serve the greater Philadelphia area (∼5,000,000 residents). YNHH serves the New Haven area and the eastern part of southern

Results

The present study reviewed 23 cases of self-inflicted abdominal injuries in 22 patients (Table 1). One patient accounted for two cases, which occurred 6 months apart.

Sixteen of the patients were males. Age distribution was bimodal with peaks before 50 and after 65 years. The mean age of male, female and all patients was 41, 39 and 40 years, respectively.

Most patients had an established psychiatric history (17/23) which included affective disorders (10/23), psychotic disorders (2/23), and

Discussion

The main finding of the present study is that abdominal and retroperitoneal injuries from self-inflicted ASWs in patients who present alive to the Emergency Department can be significant but most likely non-lethal. This is evidenced by the ISS, RTS and GCS of the patients as well as by their haemodynamic stability and the lack of injury-related mortality. In agreement with this observation, a recent study of 10 psychiatric patients with self-stabbing of which 9 were located in the abdomen, also

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When crime scene investigators (CSIs) encounter crime scenes with large volumes of blood, some selection and prioritization is often needed, and this will impact on what blood is and is not available for forensic analysis. What factors influence CSIs decision making process is largely unknown. This study examines the effects of awareness of limited resources and irrelevant contextual case information indicating either a homicide or a suicide on CSIs collection of blood traces. To this end, two scenario-based experiments with CSIs and novices were conducted. Overall, the results suggest that even when CSIs decisions are made under identical conditions, their trace selection varies both when it comes to numbers and locations. Furthermore, awareness of limited resources made CSIs collect fewer traces and their selections also varied following the contextual case information, showing similarities and differences with novices. Since blood traces can be used to establish both activity and identity the findings can have important implications for the subsequent investigation as well as trial.
Deliberate self-harm and trauma – A descriptive analysis from a London major trauma centre
2023, Injury
The objective of this study is to present a retrospective analysis of patients presenting to a Major Trauma Centre (MTC) following deliberate self-harm (DSH) and identifying the precipitants of DSH and psychiatric morbidity that will serve to inform the provision of care for these patients.
This was a retrospective observational study from a London Major Trauma Centre that identified all injured patients that presented with deliberate self-harm. Data was analysed from our established trauma database. The data was analysed using descriptive statistics.
This included 347 patients of whom 253 were male and 94 were female. The median age was 36 (range 14–93) years. Penetrating injuries (shooting and stabbing) occurred in 187 (54%) patients and blunt injuries in 160 (46%) patients. Self-stabbing (52%) was the most common cause for presentation followed by jumping from a height (26%). The median Injury Severity Score (ISS) was 4 (range 1–9). The median LOS was 3 days (range 0–109), with a mean stay of 8 days. Over half of the patients (n = 189) had previous contact with mental health services. Social and mental health were the main triggers for DSH.
Societal and economic factors as well as a mental disorder are associated with trauma related DSH. These complex group of patients presenting to MTCs have not only acute surgical needs but social and psychological as well. Raising awareness of patients’ mental health needs across the whole pathway for the major trauma patient is crucial to ensure that appropriate risk assessments are undertaken at every stage. It is also essential to provide psychological support to the multi-disciplinary team for their wellbeing.
Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent
2021, Journal of Surgical Research
Although there is evidence that self-inflicted abdominal stab wounds are less severe than those from assault, it is unclear if this is true in other anatomic regions. This study compares severity and injury pattern between self-inflicted stab wounds (SISWs) and wounds from assault (ASW).
Stab wounds from our level I trauma registry from 2013 to 2018 were reviewed. Data included age, gender, self-inflicted versus assault, psychiatric or substance use history, anatomic location, operative intervention, injury severity, length of stay, and outcomes.
Over the study period, 1390 patients were identified. History of psychiatric diagnoses or previous suicide attempts was more frequent in SISWs (47% versus 6.5%, P < 0.01; 35% versus 0.4%, P < 0.01). SISWs had a higher incidence of wounds to the neck and abdomen (44% versus 11%, P < 0.01; and 34% versus 26%, P = 0.02). Overall, injuries from ASW had a higher injury severity score, but more procedures were performed on SISWs (46% versus 34%, P < 0.01). SISWs to the neck were more likely to undergo procedures (26% versus 15%, P = 0.04). Median hospital charges were higher in patients with SISWs ($58.6 K versus $39.4 K, P < 0.01).
SISWs have a distinct pattern of injuries, more commonly to the neck and abdomen, when compared with injuries resulting from ASW. The patients with SISWs have a higher rate of procedures, longer length of stay, and higher hospital charges despite low injury severity overall.
Should the management approach to the anterior abdominal stab wound be different in patients with self-inflicted abdominal injury?
2021, Injury
Self-inflicted injury is a leading cause of death worldwide. It is hypothesized that due to instincts for self-preservation, the severity of abdominal injury would be decreased following suicidal self-stabbing in comparison to stab wounds from assault, and therefore a more conservative management might be considered.
All patients with isolated abdominal stab wound (SW) admitted to 19 Trauma Centers in Israel between the years 1997 and 2018 were included in the study. Patients with self-inflicted abdominal SW (Group I) were compared to victims with abdominal SW following assault (Group II).
Group I included 9.4% (314/3324) of patients eligible for this study. Compared to Group II, Group I patients were older (median: 39 years, IQR 28,52 vs. 24 years, IQR 19,33; p<0.001), had more females (28.7% vs 4.9%, p <0.001), had longer length of hospitalization (median: 3 days vs. 2 days; p<0.001), underwent surgery more frequently (55.4% vs. 37.4%; p<0.001), and had higher mortality (2.9% vs. 0.7%; p=0.003). Possible covariates for mortality were examined and following logistic regression, self-inflicted injury remained associated with higher death rates compared to assault (OR 4.027, CI95% 1.380, 11.749; p=0.011).
In this study, patients with isolated self-inflicted abdominal injuries had higher mortality and more frequently underwent abdominal surgery.
Complex suicides: A review of the literature with considerations on a single case of abdominal self stabbing and plastic bag suffocation
2018, Forensic Science International
Citation Excerpt :
The most involved organs were liver and omentum (11/75), followed by small bowel (8/75), stomach and mesentery (both 6/75). Venara et al. [35] observed internal lesions in 4/9 cases (44%), specifically liver (2/9) and colon and epigastric pedicle (1/9), Abdullah et al. [36] in 14/23 cases of abdominal self-inflicted wounds: in this latter study the most common injured organs were stomach, duodenum, small bowel, colon, inferior vena cava and psoas muscle, the mesentery was damaged only in 3/23 cases. Unless the bag is still present, in cases of plastic bag suffocation autopsy can present great difficulty: generally, pathological features are entirely non-specific and the evaluation of the scene is essential [55].
Complex suicides are rare and consist in the use of more than one method to induce death, representing a challenging investigation for forensic pathologists. According to the several combinations reported in literature, they have been classified into “typical” (where two common suicide methods are associated) and “atypical” (where more than two methods, or infrequent combinations of suicide methods are involved). In the case discussed here, an elderly man suffering of depression was found dead inside the tool shed of his house with a knife embedded in the abdomen and two plastic bags fastened around the neck using a twine. Three other superficial stab wounds were clustered close to the penetrating lesion. Internal examination revealed haemorrhagic infiltration at the mesentery and haemoperitoneum. No evident signs of asphyxia were highlighted and the cause of death was attributed to haemorrhagic shock. This association of suicide methods has turned out to be unusual. A review of the literature concerning complex suicides, abdominal self-stabbing and plastic bag suffocation has been managed. Crime scene and details of the used tools, medical and psychiatric history of the victim and features of the internal and external lesions have been examined and compared to previous studies. Toxicological analyses were not performed.
Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds
2018, Injury
Because Japan has high suicide rates and low violent crime rates, it is likely that most abdominal stab wounds (ASWs) in Japan are self-inflicted. Although physical examination is one of the most important factors in surgical decision making, such evaluations can be difficult in patients with self-inflicted ASWs due to patient agitation and uncooperative behavior. Therefore, the self-inflicted nature of an injury may strongly affect clinical practice, particularly in Japan, but its influence remains uncertain. We hypothesized that the rates of exploratory laparotomy and nontherapeutic laparotomy (NTL) would be higher in self-inflicted patients.
We reviewed ASW patients from 2004 to 2014 in the Japan Trauma Data Bank. The rates of exploratory laparotomy and NTL were compared between self-inflicted and non-self-inflicted ASWs.
Of the 1705 eligible patients, 1302 patients (76.4%) had self-inflicted ASWs, and 403 patients (23.6%) had non-self-inflicted ASWs. Self-inflicted patients had a significantly higher rate of psychiatric history, but lower injury severity. The in-hospital mortality rate was similar between the two groups (4.5% vs. 5.2%, p = 0.576). Self-inflicted patients had significantly higher rates of exploratory laparotomy and NTL (69.1% vs. 56.7%, p < 0.001, 22.5% vs. 13.6%, p = 0.03, respectively). Self-inflicted patients were also associated with significantly longer hospital stays (10.0 [5.0–21.0] vs. 9.0 [4.0–18.0] days, P = 0.045). In a multivariable analysis, self-inflicted patients were independently associated with exploratory laparotomy (odds ratio [OR], 2.05; 95% confidence interval [CI]: 1.55–2.72) and NTL (OR, 1.61; 95% CI: 1.01–2.56).
ASWs in Japan were predominantly self-inflicted. The clinical patterns of self-inflicted ASWs had some unique features. Patients with self-inflicted ASWs had higher rates of laparotomy and NTL. Further studies are needed to develop a useful protocol specific to self-inflicted ASWs.

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Self-inflicted abdominal stab wounds

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Forensic Sci. Int.

Forensic Sci.

Forensic Sci. Int.

Harakiri: a clinical study of deliberate self-stabbing

J. Clin. Psychiatry

Patterns in sharp force fatalities—a comprehensive forensic medical study. Part 2. Suicidal sharp force injury in the Stockholm area, 1972–1984

J. Forensic Sci.

Suicide by self-stabbing in the city of Tokyo—a review of accumulated data from 1976 to 1995

Jpn. J. Legal Med.