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The Unmet Challenge of the Trauma System

William P. Schecter, MD; Carolyn Klassen, MPH; Patricia O’Connor, RN, MS; Matthew Potts, MSIV; Herbert Ochitill, MD

Arch Surg. 2005;140:902-904.

Hypothesis  We hypothesized that a significant number of injuries and deaths due to suicide occurred in patients undergoing psychiatric treatment.

Design  We performed a retrospective cohort study of patients who committed suicide and patients with intentional self-inflicted injury.

Setting  San Francisco General Hospital in San Francisco, Calif, and the San Francisco Violent Injury Reporting System.

Patients  We retrospectively reviewed the San Francisco General Hospital records for all attempted and fatal suicides during calendar years 2001 and 2002. Data were merged with suicide data collected by the San Francisco Violent Injury Reporting System.

Results  Two hundred thirty-five suicides occurred between January 1, 2001, and December 31, 2002. One hundred thirty-two patients (56%) who committed suicide had a known mental health disorder at the time of their suicide. One hundred fifteen (87.1%) of those with a known mental health disorder had received psychiatric treatment at some point. Ninety-one patients (68.9%) with a known mental health disorder who committed suicide were receiving psychiatric treatment at the time of suicide. One hundred sixty-five (70%) of those who committed suicide had a traumatic mechanism of death. During the same 2-year period, 3106 trauma patients were admitted to San Francisco General Hospital. Fifty-five (2%) sustained intentional self-inflicted injuries. Ten (18%) of the 55 patients with intentional self-inflicted injury died after arrival at San Francisco General Hospital.

Conclusion  Creation of a feedback mechanism between the trauma and mental health systems has the potential to improve psychiatric care and prevent injury and death.

Author Affiliations: Departments of Surgery (Dr Schecter, Ms O’Connor, and Mr Potts) and Psychiatry (Dr Ochitill), San Francisco General Hospital, University of California, San Francisco; City and County of San Francisco, Department of Public Health (Ms Klassen).