Epidemiology of suicide and the impact on Western trauma centers.

BACKGROUND: Suicide represents the eleventh leading cause of death in the United States. Most suicides are a result of self-directed injury and are commonly treated in trauma centers. The purpose of this article is to characterize the epidemiology of suicide in the Western Mountain states and to describe the impact of these injuries on trauma centers. METHODS: Data were accumulated from the National Trauma Data Bank, the American Association of Suicidology, and the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System. Variables analyzed included the epidemiology of suicide in relation to regional location, age, gender, mechanism of injury, mortality, disposition, Total Functional Independence Measure (TFIM) score, and length of stay in the intensive care unit versus the hospital floor. Statistical analysis was performed on select data points to demonstrate relative significance. Several comparisons were made among intentional injuries directed at oneself, at others, and unintentional injuries with respect to the above variables. RESULTS: The Western region of the country has maintained the highest suicide rates since 1990, with 8 of the 10 Western Mountain states having rates twice as high as the national average. Approximately 88% of suicides presenting to trauma centers involve firearms, stabbings, or falls, usually causing injuries that lead to significant morbidity and mortality. Suicide attempts represent 2% of all admissions to trauma centers, with two thirds of these patient dying while in the hospital. Average length of stay in the intensive care unit and on hospital floors was 2.2 and 5.2 days, respectively, which was higher than the average length of stay of either unintentional injuries or intentional injuries directed at others. CONCLUSION: The Western Mountain states represent an endemic region for suicide. Because of the violent nature of these injuries, they often require significant medical care and finances usually provided by state governments. Suicides also contribute to the morbidity and mortality in a disproportionate manner in comparison with motor vehicle crashes and homicides. In conclusion, the Western region bears a larger burden than other regions in caring for this subset of patients with respect to medical and financial resources. Increased public awareness and preventative measures can aid in reducing not only the overall incidence of suicide but also the patient load and costs that are incurred on this country's health care system.

Treatment of Post-pancreaticoduodenectomy Complications.

Pancreaticoduodenectomy is a complex operation that is becoming more common as treatment for both malignant and benign diseases. While postoperative mortality has improved over the last two decades, morbidity continues to remain high. The improvement in mortality is attributed to better perioperative care, including aggressive early diagnosis of complications and a multidisciplinary approach to their treatment. In addition to a high clinical suspicion for postoperative complications, ready access to state of the art diagnostic radiology and endoscopy are essential for the early and accurate diagnosis of complications. After the diagnosis of a complication is made, the patient should have expertise available in interventional radiology, gastroenterology, and hepatobiliary and pancreatic surgery. Optimal treatment may involve any one of these specialties or an orchestrated effort from them all. The need for a critical mass of expertise in many specialties and subspecialties has prompted the development of new tertiary centers devoted to hepaticopancreaticobiliary (HPB) diseases. These HPB centers are becoming more prevalent in the United States as the value of this subspecialty is becoming more recognized. These HPB centers should continue to show improvements in quality and cost of care in treating complex liver, pancreatic, and biliary diseases that have rapidly evolving treatment options.