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CDC Telebriefing Transcript
CDC Tracks and Analyzes Trends:
This Week's MMWR Looks at Stroke Mortality and Nonfatal Self-Inflicted Injuries

May 23, 2002

CDC MODERATOR: Thank you. This is Kathy Harben. Today, we have two CDC authors of reports in this week's Morbidity and Mortality Weekly Report.

Our first author will talk about stroke deaths. Our second author will talk about nonfatal self-inflicted injuries.

Dr. Janet Croft, and that is spelled capital C-r-o-f-t, is a heart disease and stroke expert in CDC's cardiovascular health program. She'll give a brief introduction and then we'll open it up for questions.

Dr. Croft.

DR. CROFT: Thank you.

Stroke is the third leading cause of death and one of the major causes of disability in the United States among adults.

The current report shows that almost 48 percent of the 167,000 stroke deaths that occurred in 1999 occurred before transport to a hospital or the emergency department. Additionally, almost 25 percent of stroke-related deaths among young people aged less than 65 years occurred before transport to a hospital or the emergency department.

We feel that educating the public about signs and symptoms of stroke may help promote prompt and effective treatment of stroke. The main message that CDC and its official partners, which include the America Stroke Association, the Brain Attack Coalition and other federal agencies, that we will be promoting throughout May, is that recognizing stroke symptoms and seeking prompt emergency assistance can reduce stroke death and disability.

CDC MODERATOR: Okay. We're now ready for questions.

AT&T MODERATOR: Ladies and gentlemen, if you do wish to ask a question, please press the one on your touchtone phone. You will hear a tone indicating you've been placed in queue, and you may remove yourself from the queue at any time by pressing the pound key.

If you are using a speaker-phone, please pick up your handset before pressing the numbers. Once again, if there are questions or comments, please press one at this time. One moment, please.

We've had no questions come into queue. Please continue. One moment, please. We do have a question from the line of Keith Mulvahill [ph] with Reuters. Please go ahead; your line is open.

MR. MULVAHILL: Hi. I wanted to know if you could just sort of give me a little bit about the signs and symptoms of stroke that people should know about.

DR. CROFT: Okay. There are five major signs and symptoms of a stroke, and a person could have only just one symptom but they need to recognize that symptom and dial 911 for emergency assistance as soon as possible.

The five symptoms are, first, sudden numbness or weakness; second, sudden dimness or loss of vision; third, sudden dizziness or loss of balance; fourth, a sudden severe headache, and often, people say that that's the worst headache they ever have in their lives. And fifth is confusion or difficulty speaking.

When a person experiences one of these symptoms, they should dial 911 immediately, because if you've having an ischemic stroke--and 80 percent of all strokes are ischemic--the patient needs to reach the hospital within three hours to receive a type of treatment that could potentially reduce disability.

MR. MULVAHILL: Okay; great. Thank you.

AT&T MODERATOR: If there are further questions you may press one at this time. The next question will come from the line of Meaghan Brooks with Reuters Health. Please go ahead.

MS. BROOKS: Hi. Yeah, I was just wondering how these rates presented in the MMWR for 1999 compare with past data. Could you just talk about that a bit.

DR. CROFT: We have not published a paper on past rates. This is the first report of its kind. We are working on a report that's examining the trends, over time, in these prevalences of a proportion that are experienced pre-transport. But at the present we can't report on that, what the trends are.

MS. BROOKS: Thank you.

AT&T MODERATOR: At this time we have no further questions in queue. Please continue.

CDC MODERATOR: Unless there are additional questions for Dr. Croft about stroke mortality, we'll continue now with Dr. Alex Crosby. Again, he is a suicide prevention expert in CDC's Injury Prevention and Control Program.

Dr. Crosby.

DR. CROSBY: Hello. I'm Dr. Alex Crosby with CDC's Center for Injury Prevention and Control.

Deaths and injuries resulting from self-directed violence have been increasingly recognized as an important public health issue. Two recent documents that have demonstrated this are the Surgeon General's call to action to prevent suicide and the national strategy for suicide prevention, goals and objectives for action.

Today's MMWR includes a report on self-inflicted injuries treated in emergency departments in U.S. hospitals. The findings in this report describe the magnitude of these injuries in the United States.

We can use this information to increase our understanding of self-inflicted injuries and to help monitor trends, direct future research, and evaluate intervention programs.

This article makes several important points. First, more than a quarter of a million, about 260,000 persons were treated in hospital emergency departments for nonfatal self-inflicted injuries during the year 2000. The highest rates occurred among adolescents and young adults, especially females.

A majority of the self-inflicted injuries were either poisonings or lacerations, and 60 percent were probably suicide attempts.

In this article we have identified two groups that may suffer from higher rates of self-inflicted injury. These higher rates affect adolescents and young adults aged 15 to 24 years of age, and females.

A few other findings are worth noting. While 60 percent of the injuries could be identified as probable suicide attempts, the intent was unknown or unclear for almost one-third of the injuries.

Also, almost half of the persons seen in hospital emergency departments for self-inflicted injuries were treated and released from the emergency department.

CDC is actively applying its expertise to studying and preventing self-directed violence like suicide. The agency is a partner in the development of the national strategy for suicide prevention. CDC works closely with states and communities to do some of the following things.

First, describing and tracking the problem of self-directed violence, to use research to increase the knowledge of the causes and consequences of suicidal behavior, evaluating and demonstrating ways to prevent suicidal behavior, communicating scientific information about suicide prevention, and we integrate a wide array of suicide prevention and support services.

This report highlights the burden of self-inflicted injuries in the United States. It provides a picture of groups that appear to be at risk for these types of injuries and points to the potential usefulness of this information to direct future suicide interventions and injury prevention activity.

I'll be glad to take your questions now.

AT&T MODERATOR: Once again, ladies and gentlemen, if there are questions, please press the one at this time. One moment, please.

It appears there are no questions. None have come into queue. One moment, please. We do have a question in queue from the line of Paul Simow [ph] of Reuters. Please go ahead.

MR. SIMOW: Yes. Do you have any sense of how the 264,000 in 2000 compares to other years? Is this a growing problem? Is there some sort of trend that you can spot from the study?

DR. CROSBY: We do not have a lot of data sets that give us information about nonfatal suicidal behavior in the United States. One of the things that we can make a comparison to, that helps in regard to looking at this picture of self-directed violence, is we know, for example, how many people die as a result of suicide, and in 1999, the closest year that we've got complete statistics for, there were about 29,000 people that died as a result of suicide.

Comparing that with this 260,000 that have made nonfatal attempts, we can see that there is quite a big burden, you know, a ratio of almost nine to one. For every one person that dies as a result of suicide, about nine people make nonfatal attempts.

MR. SIMOW: Thank you.

AT&T MODERATOR: We do have another question in queue from the line of Myra McKenna with the Atlanta Journal-Constitution. Please go ahead.

MS. McKENNA: Hi. Thanks for doing this and I apologize for signing in late. But to follow up on what you just said, of the--comparing the 29,000 who died to the 264,000 whose attempts were nonfatal, there's a suggestion in the paper that a certain proportion of the 264,000 were never intended to be fatal. Can you expand on that a little more.

DR. CROSBY: Surely. While we at CDC have not done any particular studies in that area, there has been other scientific research that has tried to look at those people who make suicide attempts, or nonfatal self-directed violence.

In looking closely at that group, a number of different causes, or underlying factors that play a role in why a person might try nonfatal self-directed violence, some people, when you ask them about their intent, their intent really was that they wanted to die. Whereas others are looking for a way to deal with their problem.

For some, it was a matter of trying to get someone to pay attention to the difficulty that they were in.

Others, it might have been a way to try to deal with a problem that they were currently involved in. So there are a number of different reasons why a person might try to use self-directed violence and not always is it an intent to die.

MS. McKENNA: Can you quantify, out of that 264,000, a percentage that might be actual suicide attempts, that didn't, that weren't successful versus cries for help?

DR. CROSBY: In our study, what we did do is we were able to look at medical records, and of course we were limited by the information that's on medical records, and what we were able to identify was that 60 percent of that total number were probable suicide attempts, about 10 percent possible, and 30 percent were unclear.

The reason that we were limited is, as you could imagine, in an emergency department taking care of the medical illness is the most crucial thing, and sometimes the information about what the person's intent is is not always available.

MS. McKENNA: If there's nobody else in queue, I'm going to keep asking questions. Stop me at any time.

Do you know if any of these people are recidivists?

DR. CROSBY: No. Unfortunately, we're not able to look at this in this aspect of the study but it is something for future research to take a look at.

MS. McKENNA: And are there any, among that 264,000, and then also among the 29,000 who are successful, are there any significant, I guess, demographic differences? Male versus female, black versus white, or other race or ethnicity?

DR. CROSBY: Well, one of the things that we did identify is that there seem to be higher rates among adolescents and young adults, 15 to 24 years of age. There also tended to be slightly higher rates among females, although with not statistical difference but slightly higher among females. In regards to looking at race with race and ethnicity, we were not able to distinguish between different rates among the different groups there.

MS. McKENNA: That's in the nonfatal attempts within the context of the study.

DR. CROSBY: Right.

MS. McKENNA: Can you make any kind of comparison with, over against data on successful suicide attempts?

DR. CROSBY: Well, "successful" is not the word that we often use. We talk about completed suicide, or those who die by suicide.

When you look at suicide, in general, in the United States, males die of suicide about four to one over females. About 80 percent of all the suicides in the United States are among males.

When there have been other studies that have looked at attempts, it tends to be females that attempt suicide more than males. About two to one. So there is definitely a difference when you look at the fatal versus nonfatal behavior, although in our study we didn't find very much of a difference between males and females in regard to the nonfatal self-directed.

The other thing is when you look at those who die by suicide, the highest rates are among the elderly, those over 65, and in this case what we saw with the nonfatal behavior was that the highest rates were among adolescents and young adults. That is also fairly consistent with other research that has tried to look these two types of behavior--fatal and the nonfatal.

MS. McKENNA: Okay. Is it all right if I ask another question? Am I holding up somebody else here?

AT&T MODERATOR: There are no other questions in queue, so please go ahead.

MS. McKENNA: Okay; thanks.

As you say, the data that you evaluated in this paper was from emergency department records, and thinking of what the atmosphere in an emergency department is like, and what the primary purposes of emergency medicine are, could you talk at all about mental health follow-up for any of these attempts. Do you have any data on that?

Do you know, is it happening, is it not happening? Or is referral successful?

DR. CROSBY: No, we do not know, based on our study. The one thing that we were able to look at is called disposition in regards to the emergency department, and that's why I mentioned that about half, 49 percent of those who are seen for these nonfatal injuries were treated and released from the emergency department, and it does point to, I believe, the necessity for the follow-up. There were a certain percentage that were hospitalized, others that were transferred to other hospitals.

So we were able to [inaudible] disposition.

MS. McKENNA: Is it reasonable to assume that those who are hospitalized or transferred to another institution would have gotten some mental health follow-up, or social work follow-up?

DR. CROSBY: We don't know.

MS. McKENNA: Okay. Okay. I think I've run out of questions. Thanks very much.

DR. CROSBY: You're welcome.

AT&T MODERATOR: Further questions? Please press one at this time.

It appears there are no further questions. Please continue.

CDC MODERATOR: If there are no additional questions, I will give some contact numbers for both Dr. Croft and Dr. Crosby.

Dr. Croft can be reached--and she is the stroke expert--she can be reached at (770) 488-2424. Dr. Crosby, the suicide prevention expert, can be reached at (770) 488-4902.

AT&T MODERATOR: Ladies and gentlemen, that does conclude your conference call for this morning. Thank you very much for your participation and for using AT&T Executive Teleconference Service. You may now disconnect.

Listen to the telebriefing

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