Severe penetrating trauma in Switzerland: first analysis of the Swiss Trauma Registry (STR) - Magyar, C. T. J.; Bednarski, P.; Jakob, D. A.; Schnuriger, B.; Swiss Trauma, Registry (Eur J Trauma Emerg Surg, 2021)
PURPOSE: The purpose of this study was to examine the epidemiology, demographics, injury characteristics and outcomes of patients who presented to Swiss trauma centers following severe penetrating trauma. METHODS: Swiss Trauma Registry (STR)-cohort analysis including patients with severe (ISS >/= 16 or AIS head >/= 3) penetrating trauma between 2017 and 2019. Primary outcome was mortality. Secondary outcomes were hospital and intensive care unit (ICU) length of stay (LOS), and prehospital times. RESULTS: During the 3-year study period, 134 (1.6% of entire STR) patients with severe penetrating trauma were identified [64 (48%) gunshot wounds (GSW), 70 (52%) stab wounds (SW)]. Median age was 40.5 (IQR 29.0-59.0) and 82.8% were male. Mortality rate was 50% for GSW; 9% for SW. Overall, prehospital time [incident to arrival emergency department (ED)] was 65 (IQR 45-94) minutes. The median number of patients admitted for a severe GSW/SW per center and year was 2 (range 0-14). Of 64 patients who sustained a GSW, 42 (65.6%) were self-inflicted. Mortality in self-inflicted GSW reached 66.7%, with the head being severely injured in 78.6%. The 67 patients with severe isolated torso GSW/SW had an ISS of 20 (IQR 16-26) and a mortality of 15%. Multivariable analysis identified severe chest trauma, ED Glasgow Coma Scale </= 8, age, self-infliction, massive blood transfusion and ISS as independent predictors for mortality. CONCLUSION: Severe penetrating trauma is very rare in Switzerland. Mortality ranges from 9% in SW to 67% in self-inflicted GSW. Particularly in the setting of GSW/SW to the torso, reduction in prehospital time may further improve patient outcomes.
Keywords: journalArticle; *Wounds, Gunshot/epidemiology; *Wounds, Penetrating/epidemiology/therapy; *Wounds, Stab/epidemiology; Adult; Female; Gunshot wound; Humans; Injury Severity Score; Male; Mortality; Penetrating trauma; Prehospital; Registries; Retrospective Studies; Stab wound; Swiss Trauma Registry; Switzerland/epidemiology; Trauma Centers