A review of stab wound injuries at a tertiary trauma centre in Singapore: are self-inflicted ones less severe?

Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi

Introduction

Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated.

Methods

This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality.

Results

During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23-98.35, p<0.001).

Conclusion

In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.

The nature and severity of stab wounds at tertiary care hospitals in Kingdom of Saudi Arabia

Introduction

Fights, domestic violence and street crimes are the major causes of stab wounds in the Kingdom of Saudi Arabia (KSA). The objective of the study was to describe the nature and severity of stab wounds at a tertiary care hospital in KSA.

Methods

A cross-sectional study, which included 106 patients, was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. The patients that fulfilled the inclusion criteria were recruited for the study after having confirmed their consent. The authors procured and analysed the patients' clinical notes to obtain information that was pertinent to the study. The authors recorded all data within a Microsoft Excel document. SPSS 22.0 was utilized for statistical analysis.

Results

Of 106 patients, the majority were adolescents and young adults under the age of 40 (n = 77). Eighty-seven point seven percent of patients were male and 84.0% were Saudis. Demographic details were tabulated. The top three causes were fights (20.8%) followed by domestic violence (18.9%) and street crime (17.0%). Degree of shock, stabbing zones, injury to vessels, nerves and bones, injury severity score (ISS) and Glasgow Coma Scale (GCS) were tabulated.

Conclusion

The nature and severity of stab wounds should be carefully evaluated and properly managed, as these may lead to serious complications.

The Tsukui (Japan) Yamayuri-en Facility Stabbing Mass-Casualty Incident

INTRODUCTION

In July 2016, a mass-casualty stabbing attack took place at a facility for disabled persons located in Sagamihara City (Kanagawa Prefecture, Japan). The attack resulted in 45 casualties, including 19 deaths. The study hospital dispatched physicians to the field and admitted multiple casualties. This report aimed to review the physicians' experiences and to provide insights for the formulation of response measures for similar incidents in the future.

REPORT

This incident involved 30 emergency teams and 12 fire department teams, including those from neighboring fire departments. Five physicians from three medical institutions, including the study hospital, entered the field. The Simple Triage and Rapid Treatment (START) method was used on the field. The final field triage category count was: 20 red, four yellow, two green, and 19 black tags. All the casualties (n = 26) except for the 19 black tag casualties were transported to one of six neighboring medical institutions.The median age of the transported casualties was 41 years (interquartile range [IQR] = 35.5 - 42.0). Three casualties (21.4%) were in hemorrhagic shock on arrival at the hospital. Twelve patients had multiple cervical stab wounds (median four wounds; IQR = 3.75 - 6.0). A total of 91.7% of these stab wounds were in mid-neck Zone II region. Of the 12 patients with cervical stab wounds, four (33.3%) required emergency surgery, and the rest were sutured on an out-patient basis. One patient had already been sutured on the field. All patients requiring emergency surgery had deep wounds, including those of the carotid vein, thyroid gland, nerves, and the trachea. Eight of the casualties were hospitalized at the study institution. Five of them were admitted to the intensive care unit. There were no deaths among the casualties transported to the hospitals.

CONCLUSION

Regional core disaster medical hospitals must take on a central role, particularly in the case of local disasters. Horizontal communication and interactions should be reinforced by devising protocols and conducting joint training for effective inter-department collaborations on the field.Maruhashi, T, Takeuchi, I, Hattori, J, Kataoka, Y, Asari, Y. The Tsukui (Japan) Yamayuri-en facility stabbing mass-casualty incident. Prehosp Disaster Med. 2019;34(2):203-208.