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Distribution of injuries in the subgroups (gunshot, stab and other penetrating wounds) of TraumaRegister DGU® patients with penetrating injuries (n = 9575). One injury can involve multiple body regions. Two-cavity injuries are injuries to the chest and abdomen
Source publication
Background
The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5 % of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Tra...
Context in source publication
Citations
... Das in der GewPen-Studie nachgewiesene Verletzungsmuster mit vorwiegend Verletzungen der oberen Extremität im Sinne von Abwehrverletzungen und des Kopfes/Halses als Folge von Stichverletzungen ist typisch für körperliche Auseinandersetzungen. Die weiteren betroffenen Regionen Thorax und Abdomen sind mit 30 % deutlich seltener vertreten als in anderen Patientenkollektiven mit bis zu 80 % [3]. Dass in 16 % Verletzungen von mehr Die Anaesthesiologie 7 als einer Körperregion dokumentiert wurden, spricht für die Aggressivität dieser Auseinandersetzungen. ...
Zusammenfassung
Einleitung
Penetrierende Verletzungen sind eine seltene, aber immer wieder vorkommende Einsatzsituation in der Notfallmedizin. Das Ziel der Untersuchung war es, die Häufigkeit und Verletzungscharakteristika penetrierender, gewaltassoziierter Verletzungen einer Metropolregion über einen 5‑jährigen Zeitraum zu ermitteln.
Material und Methodik
In der retrospektiven Untersuchung wurden anhand einer Datenbankabfrage der Leitstelle des Rettungsdienstbereichs Düsseldorf sämtliche rettungsdienstliche Einsätze mit penetrierenden, gewaltassoziierten Verletzungen in den Jahrgängen 2015, 2017 und 2019 identifiziert und deskriptiv analysiert. Für diejenigen Patienten, die dem überregionalen Traumazentrum (ÜTZ) zuverlegt wurden, erfolgte neben der präklinischen eine weitergehende transsektorale Analyse des innerklinischen Verlaufes.
Ergebnisse
In den 3 Jahrgängen 2015, 2017 und 2019 konnten insgesamt 266 Patienten (Alter: 33 ± 14 Jahre, männlich: 79 %) mit penetrierenden, gewaltassoziierten Verletzungen erfasst werden (2015 vs. 2017 vs. 2019: n = 81 vs. n = 93 vs. n = 92). Die am häufigsten betroffene Altersgruppe war zwischen 15 und 34 Jahre alt. Eine höhere Einsatzhäufigkeit fand sich für die Stadtbezirke Altstadt, Stadtmitte und einen weiteren Stadtteil (Oberbilk). Eine hohe Einsatzhäufigkeit fand sich in den Nächten von Samstag auf Sonntag zwischen 20.00 und 04.00 Uhr. Rettungsdiensteinsätze mit Notarztbeteiligung nahmen über die Jahrgänge zu (2015 vs. 2019: 27 vs. 42 %, p = 0,04). Als Tatwaffe kamen vorwiegend Messer (56 %), abgeschlagene Glasflaschen (18 %) und Scherben (6 %) zum Einsatz. Im ÜTZ kamen 71 aller Patienten (27 %, Injury Severity Score 11 ± 14) zur Aufnahme. Bei diesen Patienten stiegen über die Jahre der Anteil einer unmittelbar erfolgten operativen Versorgung (2015 vs. 2019: 20 vs. 35 %, p < 0,05) und ein positiver Alkoholnachweis an (2015 vs. 2019: 10 vs. 43 %, p < 0,05). Die 30-Tages-Letalität betrug 1,1 % ( n = 3).
Schlussfolgerung
Penetrierende, gewaltassoziierte Verletzungen sind relevante, aber seltene rettungsdienstliche und innerklinische Einsatzsituationen. Zukünftige Versorgungsstrategien sollten sich auf die Stationierung von Rettungskräften in Schwerpunkteinsatzbereichen („Altstadtwache“, Hauptbahnhof) und Präventionsstrategien auf Waffen- und Glas‑/Flaschenzonen ausrichten. Eine Steuerung des Alkoholkonsums sollte diskutiert werden.
... The most straightforward approach involves needle decompression for pneumothorax. Certain authors advocate not only primary decompression but also the insertion of a prehospital chest drain should be done to individuals suspected of having pneumothorax (Bieler et al., 2021)The Royal College of Surgeons supports the adoption of chest seals for open pneumothorax and acknowledges that a three-sided occlusive dressing is frequently deemed ineffective (Kotora et al., 2013). Then again, lack of facilities and tools in this rural hospital, we decided to make a self-made dressing. ...
... Penetrating head injury are mainly caused by gunshot and stab wounds. Gunshot wounds (GSWs) have higher mortality than stab wounds and have a higher incidence of intracerebral hemorrhage (ICH), and raised ICP [65,66]. Stab wounds and GSWs are also commonly associated with vascular injuries [67] that need to be evaluated by digital subtraction angiography (DSA), which is superior to CT-angiography [68]. ...
Purpose of review
To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours.
Recent findings
Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials.
Summary
Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.
... Patients with chest and abdominal injuries are more likely to be re-hospitalized due to complications [41], as was the case in case N • 2. The most common complications are wound infection, wound dehiscence, wound infection, sepsis in the early period, small bowel syndrome, and intestinal adhesions with ileus as late complications [42]. The wound infection rate (32.1%) is slightly higher compared to the overall wound infection rate [43], probably because of open bone fractures, perforating wounds, anemia, and generalized poor immune response [44]. ...
Abdominal injuries in children caused by guns are a rare clinical entity globally. But, in countries with undefined legal regulations and in war zones, urban violence is a tremendous social problem among older children and adolescents. This manuscript provides details regarding two cases of severe gunshot injuries in young children. The injuries were very complicated and included damage to the parenchymatous and hollow organs and major blood vessels. The clinical presentation on admission was severe and dramatic, but the patients survived. However, one patient developed numerous complications that required repeated surgical interventions and long treatment. This article provides a detailed description of injuries and how to treat them. Patient care requires a multidisciplinary approach, and the initial decision on further treatment depends on the patient’s hemodynamic stability.
... Stabbing injuries are of great importance in a forensic context. According to a German trauma register study, between 2009 and 2018, 4333 patients with a stabbing wound were registered, mostly associated with crimes of violence or suicide [2]. In legal proceedings, experts are often confronted with biomechanical aspects of stab wounds, for example concerning stabbing forces, kinematics of stabbing, etc. [13,21]. ...
Background
In court proceedings, forensic and biomechanical experts frequently have to estimate the stabbing forces necessary for a certain pattern of injury. Studies on this topic are rare.
Objective
Development and calibration of an experimental set-up for quantification of dynamic stabbing kinematics and forces.
Investigation of the influence of different shaped blades on stabbing forces.
Material and methods
We developed and calibrated a handle with an integrated force sensor and an accelerometer. Different blades can be attached to the handle. A total of 27 stabbings were performed by 1 volunteer at medium intensity and preferably reproducible stabbing velocities. We used three blades with different shapes. Gelatine served as tissue simulant. Maximum stabbing velocities were captured via two-dimensional high-speed videography.
Results
The force sensor calibration resulted in a nearly perfect linear regression. Stabbing velocities ranged between 2.7 and 5.0 m/s with stabbing forces between 54.8 and 129.3 N. Stabbing with the blunt blade resulted in significantly higher stabbing forces compared to pointed and serrated blades. A similar trend was observed for serrated versus pointed blades, but without statistical significance. A significant dependency of the stabbing velocity on stabbing force could only be proven for the serrated blade.
Conclusion
Blade shape and stabbing velocity are factors that can influence the resultant stabbing force. Reliable case evaluation needs the consideration of case-specific knives and circumstances.
... In Deutschland sind Schuss-und Explosionsverletzungen im Rettungsdienst selten [2]. Durch die Übernahme von Verletzten aus dem Krieg in der Ukraine in zivile Krankenhäuser und die fortwährende Bedrohung durch internationalen Terrorismus rücken diese Verletzungsentitäten zunehmend in den Fokus der zivilen Rettungs-und Versorgungsstrukturen in Deutschland [3]. ...
... No international consensus guidelines exist regarding the management of penetrating neck injuries; consequently, clinicians must rely on management algorithms from high-volume trauma centers such as those in South Africa [3,4]. In this article, the authors aim to raise emergency physicians' awareness of penetrating neck injury management principles. ...
While rare in incidence, penetrating neck injuries are often life-threatening. When a patient’s physiological status is appropriate, the first step in treatment should be a detailed preoperative imaging assessment. Formulating a treatment plan that includes computed tomography (CT) imaging and discussing the surgical approach with a multidisciplinary team before operating allows for a successful selective surgical approach.
The authors report the case of a Zone II penetrating injury with a right laterocervical entry wound in which an impaled blade with an inferomedial oblique path pierced deeply into the cervical spine. The blade missed multiple vital structures in the neck, such as the common carotid artery, jugular vein, trachea, and esophagus. The patient underwent a formal neck exploration, and controlled extraction of the blade under direct vision was achieved. Therefore, the author's recommendation for implementing any management algorithm for penetrating neck injuries should rely primarily on a multidisciplinary selective approach.
... Stab injuries are primarily observed in urban environments and predominantly affect young men between 20 and 30 years of age (1,2). In a recent retrospective analysis of~240,000 severely injured patients enrolled in the German Trauma Registry (TraumaRegister DGU ® ), 4,333 stab injuries (1.8%) were recorded between 2009 and 2018 (3). ...
Background
Knife crime has increased considerably in recent years in Northern Europe. Affected patients often require immediate surgical care due to traumatic organ injury. Yet, little is known about clinically relevant routine laboratory parameters in stab injury patients and how these are associated with intensive care unit (ICU) admission, hospitalization and number of surgeries.
Methods
We retrospectively analyzed 258 stab injury cases between July 2015 and December 2021 at an urban Level I Trauma Center. Annual and seasonal incidences, injury site, injury mechanism, Injury Severity Score (ISS), and surgical management were evaluated. First, correlations between routine laboratory parameters for hematology, coagulation, and serum biochemistry (peak, and Δ (change from admission to peak within 3 days following admission)) and length of hospital stay, ICU stay, and number of surgeries were assessed using Spearman’s rank correlation coefficients. Second, multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression analyses were conducted to identify parameters predictive of clinical outcomes. Third, longitudinal developments of routine laboratory parameters were assessed during hospital admission.
Results
In 2021, significantly more stab injuries were recorded compared with previous years and occurred less during winter compared with other seasons. Mean ISS was 8.3 ± 7.3, and ISS was positively correlated with length of hospital and ICU stay (r = 0.5–0.8, p < 0.001). Aspartate transaminase (AST) (Δ) (r = 0.690), peak C-reactive protein (CrP) (r = 0.573), and erythrocyte count (Δ) (r = 0.526) showed the strongest positive correlations for length of ICU stay for penetrating, thoracoabdominal, and organ injuries, respectively. No correlations were observed between routine laboratory parameters and number of surgeries. For patients with penetrating injuries, LASSO-selected predictors of ICU admission included ISS, pH and lactate at admission, and Δ values for activated partial thromboplastin time (aPTT), K⁺, and erythrocyte count. CrP levels on day 3 were significantly higher in patients with penetrating (p = 0.005), thoracoabdominal (p = 0.041), and organ injuries (p < 0.001) compared with those without.
Conclusion
Our data demonstrate an increase in stab injury cases in 2021 and an important link between changes in routine laboratory parameters and ICU admission and hospitalization. Monitoring ISS and changes in AST, CrP, erythrocyte count, pH, lactate, aPTT, and K⁺ may be useful to identify patients at risk and adjust surgical and ICU algorithms early on.
... In this study, penetrating torso injuries accounted for 1.1% and 0.1% of all penetrating injuries and all injuries, respectively. Although a direct comparison is difficult due to differences in the clinical characteristics of the study population, this study showed a relatively low incidence of penetrating torso injuries in Incheon over the last 5 years, similar to other industrialized countries [9][10][11]. Moreover, the incidence and mortality rates of penetrating torso injuries requiring hospitalization were relatively low [12][13][14]. ...
Purpose: Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City. Methods: Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded. Results: Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals. Conclusions: Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.
... Similarly, a FAST was less frequently performed among undertriaged patients (3.2% vs 19.1%, p < 0.0001, Table 1). Undertriaged patients were less severely injured (ISS: 22 [17][18][19][20][21][22][23][24][25][26][27][28][29] vs 25 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], p < 0.0001). A total of 15.6% (n = 50) undertriaged patients were secondarily transferred to a level-I centre. ...
... external haemorrhage, limb amputation) than blunt trauma. Furthermore, European physicians are less exposed to penetrating trauma compared to their counterparts in America [30][31][32]. ...
PurposeTo assess the incidence of undertriage in major trauma, its determinant, and association with mortality.MethodsA multicentre retrospective cohort study was conducted using data from a French regional trauma registry (2011–2017). All major trauma (Injury Severity Score ≥ 16) cases aged ≥ 18 years and managed by a physician-led mobile medical team were included. Those transported to a level-II/III trauma centre were considered as undertriaged. Multivariable logistic regression was used to identify factors associated with undertriage.ResultsA total of 7110 trauma patients were screened; 2591 had an ISS ≥ 16 and 320 (12.4%) of these were undertriaged. Older patients had higher risk for undertriage (51–65 years: OR = 1.60, 95% CI [1.11; 2.26], p = 0.01). Conversely, injury mechanism (fall from height: 0.62 [0.45; 0.86], p = 0.01; gunshot/stab injuries: 0.45 [0.22; 0.90], p = 0.02), on-scene time (> 60 min: 0.62 [0.40; 0.95], p = 0.03), prehospital endotracheal intubation (0.53 [0.39; 0.71], p < 0.001), and prehospital focussed assessment with sonography [FAST] (0.15 [0.08; 0.29], p < 0.001) were associated with a lower risk for undertriage. After adjusting for severity, undertriage was not associated with a higher risk of mortality (1.22 [0.80; 1.89], p = 0.36).Conclusions
In our physician-led prehospital EMS system, undertriage was higher than recommended. Advanced aged was identified as a risk factor highlighting the urgent need for tailored triage protocol in this population. Conversely, the potential benefit of prehospital FAST on triage performance should be furthered explored as it may reduce undertriage. Fall from height and penetrating trauma were associated with a lower risk for undertriage suggesting that healthcare providers should remain vigilant of the potential seriousness of trauma associated with low-energy mechanisms.
