Rozenfeld Michael, Peleg Kobi, Givon Adi, Kessel Boris
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, School of Public Health, Tel-Aviv, Israel.
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, School of Public Health, Tel-Aviv, Israel.
Injury. 2017 Jul;48(7):1522-1526. doi: 10.1016/j.injury.2017.04.059. Epub 2017 May 1.
When treating patients with stab injuries of the torso, clinicians often lack timely information about the degree and nature of internal organ damage. An externally observable sign significantly associated with characteristics of torso injuries may therefore be useful for practitioners. One such potential sign is the presence of wounds to the hands, sometimes sustained during victims' attempt to defend themselves during the violent altercation. Thus, the primary aim of this study was to evaluate the association between presence of upper extremity wounds and the severity of the thoracic and intra-abdominal injuries due to stabbing.
This study was carried out retrospectively using data on 8714 patients with stabbing-related injuries from 19 trauma centers that participated in the Israeli National Trauma Registry (INTR) between January 1st1997 and December 31st 2013. Patients with wounds of upper extremities in addition to torso injuries (UE group) were compared to other patients with torso injuries (TO group) in terms of demographics, injury characteristics and clinical outcome.
The compared groups were found to be homogeneous in terms of age and systolic blood pressure; the number of sustained torso injuries was also identical. The UE group comprised a slightly greater percentage of females, however both groups were predominantly male. Patients with upper extremity injuries had a lower proportion of internal organ damage (36% vs. 38.5%) and lower mortality (0.9% vs. 2%). The higher mortality of patients without upper extremity wounds remained significantly different even when adjusted by other epidemiological parameters (OR 2.46, 95% CI 1.33-5.08).The number of sustained upper extremity injuries was positively associated with deeper penetration of the torso by the stabbing instrument.
Patients with stabbing-related upper extremity wounds had a significant survival advantage over patients without such injuries. However, a greater number of sustained upper extremity wounds may be an external sign of greater severity of thoracic and intraabdominal stabbing injuries.
在治疗躯干刺伤患者时，临床医生常常缺乏关于内部器官损伤程度和性质的及时信息。因此，一种与躯干损伤特征显著相关的外部可观察体征可能对从业者有用。这样一种潜在体征是手部伤口的存在，有时是受害者在暴力冲突中试图自卫时造成的。因此，本研究的主要目的是评估上肢伤口的存在与刺伤所致胸腹部损伤严重程度之间的关联。
本研究采用回顾性研究方法，使用了1997年1月1日至2013年12月31日期间参与以色列国家创伤登记处（INTR）的19个创伤中心的8714例刺伤相关损伤患者的数据。将除躯干损伤外还伴有上肢伤口的患者（上肢组）与其他躯干损伤患者（躯干组）在人口统计学、损伤特征和临床结局方面进行比较。
发现比较组在年龄和收缩压方面具有同质性；所遭受的躯干损伤数量也相同。上肢组女性比例略高，但两组主要为男性。有上肢损伤的患者内部器官损伤比例较低（36%对38.5%），死亡率也较低（0.9%对2%）。即使在通过其他流行病学参数进行调整后，没有上肢伤口的患者较高的死亡率仍然存在显著差异（比值比2.46，95%置信区间1.33 - 5.08）。所遭受的上肢损伤数量与刺伤器械对躯干的更深穿透呈正相关。
与刺伤相关的上肢伤口患者比没有此类损伤的患者具有显著的生存优势。然而，更多的上肢伤口可能是胸腹部刺伤更严重的外部体征。
