Skip to main content
SpringerLink
Log in

Severe penetrating trauma in Switzerland: first analysis of the Swiss Trauma Registry (STR)

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Upon request.

Code availability

Not applicable.

References

  1. United Nations Development Programme. Human Development Report 2020. http://hdr.undp.org/en/countries/profiles/CHE#. Accessed 2 Jun 2021.

  2. Federal Statistical Office Section Crime and Criminal Justice Switzerland. Police crime statistics Switzerland [Internet]. https://www.bfs.admin.ch/bfs/en/home/statistics/crime-criminal-justice/police.html#tables__content_bfs_en_home_statistiken_kriminalitaet-strafrecht_polizei_jcr_content_par_tabs. Accessed 8 Jan 2021.

  3. Gennarelli TA, Wodzin E. Medicine. A for the A of A. Abbreviated injury scale 2005: update 2008. Barrington: Association for the Advancement of Automative Medicine; 2008.

    Google Scholar 

  4. Tran A, Lamb T, Taljaard M, Fernando SM, Inaba K, Moore EE, et al. Current practices and challenges in assessing traumatic hemorrhage: an international survey of trauma care providers. J Trauma Acute Care Surg. 2021;90:E95-100.

    Article  Google Scholar 

  5. Inaba K, Teixeira PGR, Shulman I, Nelson J, Lee J, Salim A, et al. The impact of uncross-matched blood transfusion on the need for massive transfusion and mortality: analysis of 5166 uncross-matched units. J Trauma Inj Infect Crit Care. 2008;65:1222–6.

    Article  Google Scholar 

  6. Kobayashi L, Coimbra R, Goes AMO, Reva V, Santorelli J, Moore EE, et al. American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg. 2020;89:1197–211.

    Article  Google Scholar 

  7. Biffl WL, Leppaniemi A. Management guidelines for penetrating abdominal trauma. Present 9th Annu Electr Util Environ Conf [Internet] Springer US. 2015;39:1373–80. https://doi.org/10.1007/s00268-014-2793-7.

    Article  Google Scholar 

  8. Bieler D, Kollig E, Hackenberg L, Rathjen J-H, Lefering R, Franke A. Penetrating injuries in Germany—epidemiology, management and outcome—an analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med [Internet]. 2021. https://doi.org/10.21203/rs.3.rs-135820/v1.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Thoeni N, Reisch T, Hemmer A, Bartsch C. Suicide by firearm in Switzerland: who uses the army weapon? Results from the national survey between 2000 and 2010. Swiss Med Wkly 2018 1483738 [Internet]. EMH Media. 2018;148:14646. https://smw.ch/article/doi/smw.2018.14646. Accessed 9 Aug 2021.

  10. Hadjizacharia P, Brown CVR, Teixeira PGR, Chan LS, Yang K, Salim A, et al. Traumatic suicide attempts at a level I trauma center. J Emerg Med Elsevier. 2010;39:411–8.

    Article  Google Scholar 

  11. Quenzer F, Givner A, Dirks R, Coyne CJ, Ercoli F, Townsend R. Self-inflicted gun shot wounds: a retrospective, observational study of U.S. Trauma Centers INTRODUCTION Intentional self-harm (suicide) is a growing problem in the. West J Emerg Med [Internet]. 2021;518. http://escholarship.org/uc/uciem_westjem. Accessed 8 Jul 2021.

  12. Dente CJ, Shaz BH, Nicholas JM, Harris RS, Wyrzykowski AD, Ficke BW, et al. Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level I trauma center. J Trauma Inj Infect Crit Care. 2010;68:298–304.

    Article  Google Scholar 

  13. Teixeira PGR, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63:1338–47.

    PubMed  Google Scholar 

  14. Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, et al. Died of wounds on the battlefield: Causation and implications for improving combat casualty care. J Trauma Inj Infect Crit Care. 2011;71:4–8.

    Article  Google Scholar 

  15. Grigorian A, Nahmias J, Chin T, Allen A, Kuncir E, Dolich M, et al. Patients with gunshot wounds to the torso differ in risk of mortality depending on treating hospital. Updates Surg [Internet]. 2019;71:561–7. https://doi.org/10.1007/s13304-019-00657-w (Springer International Publishing).

    Article  Google Scholar 

  16. Allen SR, Scantling DR, Delgado MK, Mancini J, Holena DN, Kim P, et al. Penetrating torso injuries in older adults: increased mortality likely due to “failure to rescue.” Eur J Trauma Emerg Surg. 2015;41:657–63.

    Article  CAS  Google Scholar 

  17. Fu C-Y, Bajani F, Bokhari M, Butler C, Starr F, Messer T, et al. Association between Torso Gunshot wound volumes of trauma centers and outcomes of Torso Gunshot wound patients. A propensity-matched nationwide cohort study. Prehospital Emerg Care [Internet]. 2020. https://doi.org/10.1080/10903127.2020.1852353 (Taylor & Francis).

    Article  PubMed  Google Scholar 

  18. Alarhayem AQ, Myers JG, Dent D, Liao L, Muir M, Mueller D, et al. Time is the enemy: Mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour.” Am J Surg [Internet]. 2016;212:1101–5. https://doi.org/10.1016/j.amjsurg.2016.08.018 (Elsevier Inc.).

    Article  CAS  PubMed  Google Scholar 

  19. Kidher E, Krasopoulos G, Coats T, Charitou A, Magee P, Uppal R, et al. The effect of prehospital time related variables on mortality following severe thoracic trauma. Injury [Internet]. 2012;43:1386–92. https://doi.org/10.1016/j.injury.2011.04.014 (Elsevier Ltd).

    Article  PubMed  Google Scholar 

  20. Berg RT, Inaba K, Okoye O, Karamanos E, Strumwasser A, Chouliaras K, et al. The peril of thoracoabdominal firearm trauma: 984 civilian injuries reviewed. J Trauma Acute Care Surg. 2014;77:684–91.

    Article  Google Scholar 

  21. Bedard AF, Mata LV, Dymond C, Moreira F, Dixon J, Schauer SG, et al. A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes. Int J Emerg Med. 2020;13(1):64.

    Article  Google Scholar 

  22. Rappold JF, Bochicchio GV. Surgical adjuncts to noncompressible torso hemorrhage as tools for patient blood management. Transfusion. 2016;56:S203–7 (Blackwell Publishing Inc.).

    Article  Google Scholar 

  23. Swaroop M, Straus DC, Agubuzu O, Esposito TJ, Schermer CR, Crandall ML. Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma. J Emerg Trauma Shock. 2013;6(1):16–20.

    Article  Google Scholar 

  24. Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med [Internet]. 1994;331:1105–9. https://doi.org/10.1056/NEJM199410273311701 (Massachusetts Medical Society).

    Article  CAS  PubMed  Google Scholar 

  25. Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet J-F. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg [Internet]. 2007;245:812. /pmc/articles/PMC1877079/. Accessed 8 Jul 2021. (Lippincott, Williams, and Wilkins).

  26. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma Inj Infect Crit Care. 2008;64:1211–7.

    Article  Google Scholar 

  27. Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Prim 2021 71 [Internet]. 2021;7:1–23. https://www.nature.com/articles/s41572-021-00264-3. Accessed 8 Jul 2021. (Nature Publishing Group).

  28. Harmsen AMK, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury [Internet]. 2015;46:602–9. https://doi.org/10.1016/j.injury.2015.01.008 (Elsevier Ltd).

    Article  CAS  PubMed  Google Scholar 

  29. Wan-Ting C, Chin-Hsien L, Cheng-Yu L, Cheng-Yu C, Chi-Chun L, Keng-Wei C, et al. Reverse shock index multiplied by Glasgow coma Scale (rSiG) predicts mortality in severe trauma patients with head injury. Sci Rep. 2020;10(1):2095.

    Article  Google Scholar 

  30. CA D, R C, RS P, LS N, RMC de S. Domingues CA, Coimbra R, Poggetti RS, Nogueira LS, de Sousa RMC. New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction. World J Emerg Surg [Internet]. 2018;13. https://pubmed.ncbi.nlm.nih.gov/29541155/. Accessed 18 Sep 2021.

  31. McMahon DJ, Schwab W, Kauder D. Comorbidity and the elderly trauma patient. World J Surg. 1996;20(8):1113–9.

    Article  CAS  Google Scholar 

  32. McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban level I trauma center. Ann Emerg Med [Internet]. 2013;61:167–74. https://doi.org/10.1016/j.annemergmed.2012.08.026 (Elsevier Inc.).

    Article  PubMed  Google Scholar 

  33. Jarvis S, Salottolo K, Berg GM, Carrick M, Caiafa R, Hamilton D, et al. Examining emergency medical services’ prehospital transport times for trauma patients during COVID-19. Am J Emerg Med [Internet]. 2021/02/03. The Author(s). 2021;44:33–7. https://pubmed.ncbi.nlm.nih.gov/33578329/. Accessed 8 Jul 2021. (Published by Elsevier Inc.).

  34. Seamon MJ, Doane SM, Gaughan JP, Kulp H, D’Andrea AP, Pathak AS, et al. Prehospital interventions for penetrating trauma victims: a prospective comparison between Advanced Life Support and Basic Life Support. Injury [Internet]. 2013;44:634–8. https://doi.org/10.1016/j.injury.2012.12.020 (Elsevier Ltd).

    Article  PubMed  Google Scholar 

  35. Rappold JF, Hollenbach KA, Santora TA, Beadle D, Dauer ED, Sjoholm LO, et al. The evil of good is better: making the case for basic life support transport for penetrating trauma victims in an urban environment. J Trauma Acute Care Surg. 2015;79:343–8.

    Article  Google Scholar 

  36. Diaz MA, Hendey GW, Bivins HG. When is the helicopter faster? A comparison of helicopter and ground ambulance transport times. J Trauma Inj Infect Crit Care. 2005;58:148–53.

    Article  Google Scholar 

  37. Crandall M, Sharp D, Unger E, Straus D, Brasel K, Hsia R, et al. Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. Am J Public Health [Internet]. 2013;103:1103. /pmc/articles/PMC3698742/. Accessed 9 Aug 2021.. (American Public Health Association).

  38. Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, et al. Access to Trauma Centers in the United States. JAMA [Internet]. 2005;293:2626–33. https://jamanetwork.com/journals/jama/fullarticle/200997. Accessed 9 Aug 2021. (American Medical Association).

  39. Jarman MP, Hashmi Z, Zerhouni Y, Udyavar R, Newgard C, Salim A, et al. Quantifying geographic barriers to trauma care: Urban-rural variation in prehospital mortality. J Trauma Acute Care Surg. 2019;87:173–80.

    Article  Google Scholar 

  40. Alanazy ARM, Wark S, Fraser J, Nagle A. Factors impacting patient outcomes associated with use of emergency medical services operating in urban versus rural areas: a systematic review. Int J Environ Res Public Health [Internet]. 2019;16. /pmc/articles/PMC6572626/. Accessed 9 Aug 2021. (Multidisciplinary Digital Publishing Institute (MDPI)).

Download references

Funding

Open Access funding provided by the University of Bern. This project did not receive particular funding.

Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland

    Christian T. J. Magyar & Beat Schnüriger

  2. Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland

    Piotr Bednarski & Dominik A. Jakob

Authors
  1. Christian T. J. Magyar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Piotr Bednarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominik A. Jakob
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beat Schnüriger
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the “Swiss Trauma Registry”

Contributions

CTJM: study design, literature review, data analysis, data interpretation, writing; PD: data collection; DJ: data collection, critical revision; BS: study design, data interpretation, writing, critical revision.

Corresponding author

Correspondence to Beat Schnüriger.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval and consent to participate

The STR fulfils the requirements of the Swiss human research act (Humanforschungsgesetz, HFG) and has been registered as a multicentric registry by the ethics committee of the canton Bern (EK Bern 296/2014). This specific study has been registered and accepted by the ethics committee of the canton Bern (EK Bern 2020-02778). The 1964 Helsinki Declaration and its later amendments and comparable ethical standards were obeyed. There were no animal studies performed by any of the authors for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Magyar, C.T.J., Bednarski, P., Jakob, D.A. et al. Severe penetrating trauma in Switzerland: first analysis of the Swiss Trauma Registry (STR). Eur J Trauma Emerg Surg 48, 3837–3846 (2022). https://doi.org/10.1007/s00068-021-01822-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-021-01822-w

Keywords

Search

Navigation