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Baldino G, Vanin S, Burrascano G, Forzese E, Asmundo A, Ventura Spagnolo E. A case report of complex suicide in physician: attempt drugs poisoning and adhesive tape asphyxia. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00836-1. [PMID: 38839741 DOI: 10.1007/s12024-024-00836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
Complex suicides are rare occurrences that can be categorized into planned (or primary) cases and unplanned (or secondary) cases. Additionally, individuals often select suicide methods based on their availability and accessibility. The body of a 58-year-old man was discovered deceased inside his medical office. He was found seated on the waiting room sofa, with his airways obstructed by several layers of adhesive tape wrapped around his head. An intravenous needle was observed in his left arm, and on the table in front of him, an empty 50 ml syringe, two empty vials of 10 ml potassium chloride, and an empty 10 mg vial of Valium (diazepam) were found. A roll of adhesive tape, similar to the one around his head, was also present. The autopsy, conducted 36 h after the body's discovery, revealed therapeutic concentrations of diazepam and its metabolite nordiazepam in the blood samples, while potassium chloride was not detected. Integrating forensic findings obtained from autopsy, histology, and other postmortem investigation, including toxicological analysis, can aid in defining suicidal behavior and preventing misinterpretation, particularly in differentiating diagnosis between homicide and suicide. It is crucial to consider circumstantial data and professional knowledge in such cases.
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Affiliation(s)
- Gennaro Baldino
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Stefano Vanin
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, 16132, Italy
| | - Giorgia Burrascano
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Elena Forzese
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Alessio Asmundo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Elvira Ventura Spagnolo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
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Simonit F, Sciarappa OE, Bassan F, Scorretti C, Giudici F, Desinan L. Complex and complicated suicides in Friuli (1993-2017). MEDICINE, SCIENCE, AND THE LAW 2021; 61:14-24. [PMID: 33591875 DOI: 10.1177/0025802420934661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Complex suicides involve more than one suicide method. According to the intention of the victim, they are classified as 'planned' when the use of more than one suicide technique has been previously devised by the victim and 'unplanned' when the first method turns out to be too painful or insufficient to cause death, and the individual then resorts to other means of suicide. Complicated suicide, on the other hand, is a term that was introduced by Töro and Pollak, in which a failed act of suicide is followed by traumatisation, which has a fatal outcome. This type of death must be distinguished from complex suicides. From a sample of 1160 fatalities (837 males) between 1993 and 2017, we identified 20 (1.72%) cases of complex suicide and three (0.26%) cases of complicated suicide. We considered age, sex, psychiatric history, previous suicide attempts, suicide methods and eventual secondary traumatisation. We also compared planned and unplanned complex suicides. The results show a higher number of planned complex suicides (16 vs. 4), a prevalence of males (n = 17) and adults (median age = 48 years, range 21-74 range). Plastic bag suffocation and gas inhalation (n = 8) were the most commonly used methods. Firearms (n = 4) were used exclusively by males in planned complex suicides. Wrist and forearm cuts (n = 5) were found in four unplanned and one planned complex suicides, and all of the cases with known previous suicidal attempts (n = 3) involved planned complex suicides. Complicated suicides concerned three male victims in two failed attempts of hanging and an unforeseen carbon monoxide intoxication following a non-fatal gunshot to the mouth, confirming the rarity of these fatalities.
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Affiliation(s)
- Francesco Simonit
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Orazio Elia Sciarappa
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, Italy
| | - Fabio Bassan
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Carlo Scorretti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Legal Medicine, Italy
| | - Fabiola Giudici
- Biostatistic Unit, Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Lorenzo Desinan
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, Italy
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van den Hondel KE, Punt P, Dorn T, Ceelen M, Aarts F, van der Zande D, van Kuijk S, Duijst W, Stumpel R, van Mesdag T, Vervoort W, IJzermans A, de Vries P, Verweij J, van Remmen J, Van Hooren R, Kruyver B, Buster M, Reijnders UJL. Suicide by helium inhalation in the Netherlands between 2012 and 2019. Forensic Sci Int 2020; 318:110566. [PMID: 33168418 DOI: 10.1016/j.forsciint.2020.110566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2012 and 2013 a movie and a book about a 'dignified end of life' were published in the Netherlands. These items described suicide using an 'exit bag' to establish asphyxiation using helium (the helium method). 'Right-to-die-organisations' inform the elderly about this method. The purpose of this study is to investigate whether the use of suicidal asphyxiation by means of the helium method substituted other, related, methods following its publication in the Netherlands. MATERIAL AND METHODS We analysed suicides in the Netherlands over the period from 1 July 2012 to 30 June 2019. We compared the number of deaths caused by the helium method with other, related, cases. Secondly, we related these deaths to the total number of inhabitants and suicides recorded by Statistics Netherlands. RESULTS The study showed a stable trend in the use of the helium method in the period 2012-2019 and this was the same for the other, related methods. Individuals using the helium method were significantly younger than those using other, related, methods. At the scene of death, information about suicide and suicide notes were found more often at 'helium method' cases than with the 'other, related, methods' cases. Family was significantly more often present during a helium method suicide than during suicide by other, related, methods. DISCUSSION The number of suicides by the helium method and other, related, cases is stable in the Netherlands over the past years. Therefore, we conclude that there is no substitution effect within this category of suicides. Whilst 'right-to-die-organisations' strive to inform the old and sick of the helium method, it is noteworthy that the individuals using the helium method are significantly younger than the individuals who choose other, related, methods.
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Affiliation(s)
| | - Priscilla Punt
- Forensic Physicians Rotterdam Rijnmond, Rotterdam, the Netherlands
| | - Tina Dorn
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Manon Ceelen
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Francée Aarts
- Public Heath Service, Department of Forensic Medicine, Nijmegen, the Netherlands
| | - Dianne van der Zande
- Public Heath Service, Department of Forensic Medicine, The Hague, the Netherlands
| | - Sieb van Kuijk
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - Wilma Duijst
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - René Stumpel
- Public Heath Service, Department of Forensic Medicine, Bussum, the Netherlands
| | - Taco van Mesdag
- Public Heath Service, Department of Forensic Medicine, Groningen, the Netherlands
| | - Will Vervoort
- Public Heath Service, Department of Forensic Medicine, Tilburg, the Netherlands
| | - Anke IJzermans
- Public Heath Service, Department of Forensic Medicine, Den Bosch, the Netherlands
| | - Philip de Vries
- Public Heath Service, Department of Forensic Medicine, Leiden, the Netherlands
| | - Jeroen Verweij
- Public Heath Service, Department of Forensic Medicine, Utrecht, the Netherlands
| | - Jacquo van Remmen
- Public Heath Service, Department of Forensic Medicine, Gelderland Midden, the Netherlands
| | - Roland Van Hooren
- Public Heath Service, Department of Forensic Medicine, Maastricht, the Netherlands
| | - Bart Kruyver
- Public Heath Service, Department of Forensic Medicine, Hollands Noorden, the Netherlands
| | - Marcel Buster
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Udo J L Reijnders
- Public Health Service, Department of Forensic Medicine, Amsterdam, the Netherlands
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Kinoshita H, Tanaka N, Yasumoto-Takakura A, Abe H, Maebashi K, Tsuboi A, Iwase H, Iwadate K, Osawa M, Kitamura O. Appropriate samples for helium detection in postmortem investigations. Leg Med (Tokyo) 2020; 47:101784. [DOI: 10.1016/j.legalmed.2020.101784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
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Forrester MB. Helium inhalation injuries managed at emergency departments. Clin Toxicol (Phila) 2020; 59:138-141. [PMID: 32527163 DOI: 10.1080/15563650.2020.1776871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Helium is a colorless, odorless, and tasteless inert gas. Inhaling helium can temporarily result in a high-pitched, squeaky voice. Individuals also may inhale helium to become intoxicated or commit suicide. The objective of this study was to characterize helium inhalations managed at emergency departments (EDs). METHODS Data were obtained from the National Electronic Injury Surveillance System (NEISS), a database of consumer product-related injuries collected from the EDs of approximately 100 United States hospitals. Helium inhalation-related injuries reported during 2000-2019 were identified by reviewing the record narratives for the term "helium." The distribution of the national estimate was determined for selected variables. RESULTS A total of 89 helium inhalation-related injuries were identified, resulting in a national estimate of 2,186 injuries. The estimated number of injuries was 99 during 2000-2004, 305 during 2005-2009, 864 during 2010-2014, and 918 during 2015-2019. The age distribution was 75 (3.4%) 0-5 years, 1,427 (65.3%) 6-12 years, 586 (26.8%) 13-19 years, and 98 (4.5%) 20 years or older; 1446 (66.1%) of the patients were male. The most commonly reported symptoms or injuries were 1500 (68.6%) syncope, 615 (28.1%) non-concussion head injury, 299 (13.7%) dizziness/lightheaded, 267 (12.2%) contusion/abrasion, and 236 (10.8%) concussion. The patient was treated or evaluated and released in 2149 (98.3%) estimated injuries. CONCLUSION The majority of patients with helium inhalation-related injuries treated at United States EDs were age 6-12 years and male. Most of the patients experienced either syncope or dizziness/lightheadedness and were released from the ED.
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The rise of suicides using a deadly dose of barbiturates in Amsterdam and Rotterdam, the Netherlands, between 2006 and 2017. J Forensic Leg Med 2020; 70:101916. [DOI: 10.1016/j.jflm.2020.101916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/23/2022]
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Katayama Y, Matsuyama T, Kitamura T, Hirose T, Kiguchi T, Sado J, Kiyohara K, Takahashi H, Adachi S, Noda T, Izawa J, Ohnishi M, Shimazu T. Prehospital characteristics, incidence trends, and outcome of emergency self-inflicted injury patients with gas substances: a population-based descriptive study in Osaka, Japan. Acute Med Surg 2019; 7:e452. [PMID: 31988764 PMCID: PMC6971468 DOI: 10.1002/ams2.452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/22/2019] [Indexed: 12/05/2022] Open
Abstract
Aim Little is known about the detailed characteristics of patients using gas substances for self‐inflicted injury in prehospital settings. The aim of this study was to investigate the characteristics, incidence trends, and outcomes of patients who used gas substances for self‐inflicted injury in Osaka City, Japan, using ambulance records. Methods This was a retrospective observational study that used data from 2009 to 2015. We extracted details from ambulance records of self‐inflicted injury patients who used gas substances. The annual incidence of self‐inflicted injury by gas substance and age group and Poisson regression models were applied for calculating the annual incidence trend by type of gas substance. The main outcome was confirmed death at the scene, and we also calculated the crude odds ratios and 95% confidence intervals for each gas substance. Results During the study period, there were 324 self‐inflicted injury patients who used gas substances. The most commonly used gases were carbon monoxide (CO) (54.9%), followed by hydrogen sulfide (12.7%), helium (6.5%). The incidence of CO and hydrogen sulfide have subsequently decreased (P for trend = 0.023 and <0.001, respectively); however, the incidence of helium did not change during the study period (P for trend = 0.586). The mortality rate was highest in patients who used helium (66.7% [14/21]) and the crude odds ratio of helium was 3.857 (95% confidence interval, 1.267–11.745; P = 0.017) compared with hydrogen sulfide. Conclusion This study revealed that the incidence of self‐inflicted injury with helium did not change and its proportion of death at the scene was high in Osaka City.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan.,Emergency and Critical Care Center Osaka Police Hospital Osaka Japan
| | | | - Junya Sado
- Department of Health and Sport Sciences Medicine for Sports and Performing Arts Osaka University Graduate School of Medicine Suita Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Medicine Kansai Medical University Hirakata Japan
| | - Shingo Adachi
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Junichi Izawa
- Intensive Care Unit Department of Anesthesiology The Jikei University School of Medicine Tokyo Japan
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
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9
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Abstract
OBJECTIVE The aim of this study was to investigate choice of suicide method in individuals aged 65 years and over. METHODS Data were obtained from the Queensland Suicide Register, Australia. Univariate and multi-variate logistic regression analyses were conducted. RESULTS The predominant methods in older adults were hanging (21.5%), firearms and explosives (20.9%), drug poisoning (18.5%), followed by other poisoning (mainly MVCO) (12.6%), suffocation by plastic bag (8.5%), and drowning (6%). Some methods (e.g. firearms and explosives, drug poisoning, suffocation) appeared characterised by profiles (e.g., socio-demographic and clinical aspects), meanwhile others were not well distinguishable. Compared to other methods, those who died by firearms and explosives were significantly more likely to be males, Australian born, live in rural and remote areas, and less likely to have a mental illness, previous suicide attempt(s) or leave a suicide note. Those who died by drug poisoning were more likely to be females, leave a suicide note, experience interpersonal conflict and live in urban areas. Similarly, those who chose suffocation by plastic bag were more likely to be older females, leave a suicide note, and pay attention to suicide in the media, but less likely to experience interpersonal conflict. CONCLUSION Acceptability, availability and lethality are important factors impacting choice of means and should be considered when designing suicide prevention activities in older adults.
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Affiliation(s)
- Yu Wen Koo
- a Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University , Brisbane
| | - Kairi Kõlves
- a Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University , Brisbane
| | - Diego de Leo
- a Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University , Brisbane
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Helium poisoning: new procedure for sampling and analysis. Int J Legal Med 2019; 133:1809-1818. [DOI: 10.1007/s00414-019-02014-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Sinyor M, Williams M, Vincent M, Schaffer A, Yip PSF, Gunnell D. Suicide deaths by gas inhalation in Toronto: An observational study of emerging methods of suicide. J Affect Disord 2019; 243:226-231. [PMID: 30248633 DOI: 10.1016/j.jad.2018.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Suicide death by gas inhalation has been the subject of global scientific interest due to a rapid increase in the use of helium and charcoal gas for suicide. These may be particularly amenable to means restriction strategies. There has been little scientific attention of this phenomenon in Canada. METHODS A review of coroner records was conducted for all suicide deaths in Toronto (1998-2015). Deaths were categorized as due to inhalational asphyxia by compressed gas (i.e. helium or nitrogen), charcoal burning or motor vehicle exhaust, with suicide deaths by other methods as a comparator. Demographic, clinical and suicide specific differences between decedents in these four categories were compared using chi-squared or ANOVA global test of significance with additional pairwise comparisons where appropriate. Secular trends were also examined. RESULTS Gas inhalational deaths accounted for 190 (4.7%) of all suicides in Toronto (n = 4062) over the study period and a higher proportion of males used compressed gas or motor vehicle exhaust gases than those who died by other methods (83.3% and 84.0% vs.69.7%, both p = 0.01). Comparing 1998-2003 to 2010-2015 there was a 1075% increase in deaths by helium (4 vs. 43 deaths) and a 533% increase in deaths by charcoal burning (3 vs. 16 deaths) although helium and charcoal burning deaths still accounted for only 4.2% of total suicides 2010-2015. Deaths by helium were more likely to be accompanied by the book "Final Exit" than those by non-inhalational methods (15% vs. 0.7%, p < 0.0001) while 13 of 14 people who died by charcoal burning whose ethnicity could be determined were Asian. LIMITATIONS Ethnicity and specific details of procurement of suicide methods were not systematically available in coroner records. DISCUSSION Suicide by inhalational asphyxia, particularly by compressed gases, has increased substantially over time in Toronto consistent with observations in other countries. Increased surveillance of these deaths, efforts to restrict access to these methods, and timely interventions including minimizing media reporting are all warranted.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Marissa Williams
- Sunnybrook Health Sciences Centre, Toronto, Canada; Athabasca University, Athabasca, Alberta, Canada
| | | | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul S F Yip
- Centre for Suicide Research and Prevention, Hong Kong; University of Hong Kong, Hong Kong
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Complex suicides: A review of the literature with considerations on a single case of abdominal self stabbing and plastic bag suffocation. Forensic Sci Int 2018; 290:297-302. [DOI: 10.1016/j.forsciint.2018.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 11/22/2022]
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Sasso R, Bachir R, El Sayed M. Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality. West J Emerg Med 2018; 19:707-714. [PMID: 30013708 PMCID: PMC6040911 DOI: 10.5811/westjem.2018.4.37198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/30/2018] [Accepted: 04/18/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the United States (U.S.) and to identify factors associated with mortality in this population. Methods We conducted a retrospective cross-sectional study using the 2013 U.S National Emergency Department Sample database. ED visits with primary diagnoses of intentional or accidental suffocation injury, and injury by inhalation and aspiration of foreign bodies or food (ICD-9-CM codes) were included. We performed descriptive statistics to describe the study population. This was followed by multivariate analyses to identify factors associated with mortality. Results We included a total of 27,381 ED visits for suffocation injuries. Most suffered from either inhalation and ingestion of food causing obstruction of respiratory tract or suffocation (51.6%), or suicide and self-inflicted injury by hanging, strangulation, and suffocation (39.4%). Overall mortality was 10.9%. Over half (54.7%) of the patients were between 19 and 65 years old. Males were more common than females (59.1% vs. 40.9%). Over half of the patients (54.9%) were treated and released from the ED. Factors associated with increased mortality included male gender, young age (4-18 years), diseases of the cardiac, respiratory, genitourinary and neurologic systems, intentional self-harm, and self-payer status. Conclusion Mortality from suffocation injuries remains high with significant burden on children and adolescents and on patients with intentional injuries. Tailored initiatives targeting identified modifiable factors through implementation of behavioral and environmental change can reduce the risk of suffocation injury and improve clinical outcomes of affected victims.
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Affiliation(s)
- Roula Sasso
- American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon
| | - Rana Bachir
- American University of Beirut Medical Center, Department of Emergency Medicine, Emergency Medical Services and Prehospital Care Program, Beirut, Lebanon
| | - Mazen El Sayed
- American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon.,American University of Beirut Medical Center, Department of Emergency Medicine, Emergency Medical Services and Prehospital Care Program, Beirut, Lebanon
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Abstract
BACKGROUND In the limited research into suicides in older adults, they have been treated as a homogenous group without distinguishing between different age groups. This study aimed to compare differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups within older adults who died by suicide: young-old (65-74 years), middle-old (75-84 years), and oldest old (85 years and over) in Queensland, Australia, during the years 2000-2012 (N = 978). METHODS The Queensland Suicide Register was utilized for the analysis. Annual suicide rates were calculated. Odds ratios with 95% confidence intervals and χ 2 tests for trend were calculated to examine differences between the three groups. RESULTS Suicide rates were increasing with age for males, but not for females. Hanging and firearms were the predominant methods of suicides. However, suffocation by plastic bag and drowning as suicide methods increased with age, in contrast firearms and explosives decreased with age. Overall, psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased significantly with age, meanwhile physical conditions and bereavement increased with age. CONCLUSION Suicide across older adulthood is not a homogenous phenomenon. Our findings showed significant differences in the prevalence of potential risk factors within the three different age groups considered. To prevent suicide in older adults would require targeting specific factors for each subgroup while using holistic and comprehensive approaches.
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