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

European Journal of Trauma and Emergency Surgery volume 48, pages 3837–3846 (2022)Cite this article

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.

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Data availability

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Funding

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

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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
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  2. Piotr Bednarski
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  3. Dominik A. Jakob
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  4. Beat Schnüriger
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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.

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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.

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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

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

Keywords

  • Penetrating trauma
  • Gunshot wound
  • Stab wound
  • Prehospital
  • Mortality
  • Swiss Trauma Registry