Günther Mattias, Dahlberg Martin, Rostami Amir, Azadali Ali, Arborelius Ulf P, Linder Fredrik, Rostami Elham
Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Front Neurol. 2021 Nov 15;12:730405. doi: 10.3389/fneur.2021.730405. eCollection 2021.
Trauma injury is the sixth leading cause of death worldwide, and interpersonal violence is one of the major contributors in particular regarding injuries to the head and neck. The incidence, demographics, and outcomes of penetrating trauma reaching hospitals in Sweden are not known. We report the largest, nationwide epidemiological study of penetrating injuries in Sweden, using the Swedish Trauma Registry (SweTrau). A multi-center retrospective descriptive study of 4,776 patients was conducted with penetrating injuries in Sweden, between 2012 and 2018. Due to the increase in coverage of the SweTrau registry during the same period, we chose to analyze the average number of cases for the time intervals 2013-2015 and 2016-2018 and compare those trends to the reports of the Swedish National Council for Crime Prevention (Brå) as well. A total of 663 patients had Injury Severity Score (ISS) ≥ 15 at admission and were included in the study. Three hundred and sixty-eight (55.5%) were stab wounds (SW), 245 (37.0%) gunshot wounds (GSW), and 50 (7.5%) other traumas. A majority of the cases involved injuries to the head, neck, and face. SW increased from 145 during 2013-2015 to 184 during the second period of 2016-2018. The increase was greater for GSW from 92 to 141 during the same respective periods. This trend of increase over time was also seen in head, neck, and face injuries. The 30-day mortality was unaffected (48-47%) in GSW and trended toward lower in SW (24-21%) when comparing 2013-2015 with 2016-2018. Patients with head trauma had 45% mortality compared to 18% for non-head trauma patients. Head trauma also resulted in worse outcomes, only 13% had Glasgow outcome score (GOS) 5 compared to 27% in non-head trauma. The increasing number of cases of both SW and GSW corresponded well with reports from Brå although further studies also are needed to address deaths outside of hospitals and not registered at the SweTrau. The majority of cases had injuries to the head, neck, and face and were associated with higher mortality and poor outcomes. Further studies are needed to understand the contributing factors to these worse outcomes in Sweden and whether more targeted trauma care of these patients can improve outcomes.
创伤性损伤是全球第六大死因，人际暴力是主要促成因素之一，尤其是在头颈部损伤方面。瑞典医院收治的穿透性创伤的发病率、人口统计学特征及转归尚不清楚。我们利用瑞典创伤登记处（SweTrau）报告了瑞典规模最大的全国性穿透性损伤流行病学研究。对2012年至2018年期间瑞典4776例穿透性损伤患者进行了一项多中心回顾性描述性研究。由于同期SweTrau登记处的覆盖范围有所增加，我们选择分析2013 - 2015年和2016 - 2018年时间段内的平均病例数，并将这些趋势与瑞典国家预防犯罪委员会（Brå）的报告进行比较。共有663例患者入院时损伤严重程度评分（ISS）≥15并纳入研究。其中368例（55.5%）为刺伤（SW），245例（37.0%）为枪伤（GSW），50例（7.5%）为其他创伤。大多数病例涉及头、颈和面部损伤。SW从2013 - 2015年的145例增加到2016 - 2018年第二个时间段的184例。GSW在相同时间段内从92例增加到141例，增幅更大。头、颈和面部损伤也呈现出随时间增加的趋势。将2013 - 2015年与2016 - 2018年进行比较时，GSW的30天死亡率未受影响（48% - 47%），而SW的30天死亡率呈下降趋势（24% - 21%）。头部创伤患者的死亡率为45%，而非头部创伤患者为18%。头部创伤还导致更差的转归，只有13%的患者格拉斯哥预后评分（GOS）为5分，而非头部创伤患者为27%。SW和GSW病例数的增加与Brå的报告相符，不过还需要进一步研究以解决医院外死亡且未在SweTrau登记的情况。大多数病例有头、颈和面部损伤，并伴有更高的死亡率和较差的转归。需要进一步研究以了解瑞典这些较差转归的促成因素，以及对这些患者进行更有针对性的创伤护理是否能改善转归。
