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. 2025 Aug 29;26(5):1468-1477.
doi: 10.5811/westjem.42044.

Self-Harm and Interpersonal Violence-Related Injuries: Retrospective Analysis of the American College of Surgeons Trauma Quality Programs Data

Ayman El-Menyar  1   2 , Ahammed Mekkodathil  1 , Rafael Consunji  3 , Sandro Rizoli  4 , Tarik S Abulkhair  4 , Ruben Peralta  4   5 , Rifat Latifi  6 , Hassan Al-Thani  4
Affiliations

Self-Harm and Interpersonal Violence-Related Injuries: Retrospective Analysis of the American College of Surgeons Trauma Quality Programs Data

Ayman El-Menyar et al. West J Emerg Med. .

Abstract

Introduction: Violence-related injuries (VRI) such as interpersonal violence, intimate-partner violence, and self-harm injuries present a significant public health challenge in the United States. We aimed to explore interpersonal-violence and self-harm injuries, focusing on demographic disparities (age and sex) and mechanisms of injury, including firearm-related violence.

Methods: We conducted a retrospective study of VRIs among the US civilian population between 2017-2021. Data were extracted from the American College of Surgeons (ACS) Trauma Quality Programs Participant Use Files. We identified VRIs using the International Classification of Diseases, 10th Rev, with Australian modification E-code series. The dataset was categorized and compared by age, sex, ethnicity, violence intent, and mechanism of injury. This study was a secondary data analysis reporting interpersonal-violence and self-harm injuries among trauma cases from the national trauma database.

Results: The total number of trauma patients in the ACS database was 5,483,016 between 2017-2021 (1.1 million/year). The final analysis included 584,417 (11%) patients with VRIs (interpersonal violence and self-harm), with a mean age of 35 years; 82% were male, 45% White, and 42% Black. Interpersonal violence accounted for 88% of injuries, while 12% were self-harm, with firearm-related violence the most common mechanism of injury (35%). Firearm-related interpersonal violence was common among younger individuals (19-39 years), while non-weaponized interpersonal violence was prevalent among older individuals (≥ 60 years). Blacks had a higher rate of firearm-related interpersonal violence (51%), and Whites had a greater frequency of non-weaponized interpersonal violence. There were 43,089 deaths (7.4%), with 68% resulting from interpersonal-violence and 32% from self-harm injuries. Firearm-related injuries (interpersonal violence and self-harm combined) accounted for 78% of all VRI-related deaths. Mortality was higher in males (7.7%) than in females (5.9%) (P < .001).

Conclusion: There is a significant burden of violence-rated injuries in the US, particularly affecting males, racial minorities, and vulnerable age groups. Firearm-related injuries are the leading cause of death in both interpersonal-violence and self-harm cases. The increase in VRIs during the COVID-19 pandemic highlights the urgent need for targeted public health interventions focused on firearm safety, violence prevention, and mental health support.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Selection flowchart of violence-related injury cases from the dataset of the American College of Surgeons Trauma Quality Programs Participant Use File, 2017–2021. TQIP, Trauma Quality Improvement Program; E-code, external cause code
Figure 2
Figure 2
Distribution of violence-related injury mechanisms in the United States (2017–2021).
See this image and copyright information in PMC

References

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