Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Neurocentre, Turku University Hospital, Turku, Finland; Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
World Neurosurg. 2024 Feb;182:e493-e505. doi: 10.1016/j.wneu.2023.11.129. Epub 2023 Nov 29.
Penetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center.
Swedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes.
Of 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs.
Between 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.
在过去十年中，瑞典头部和颈部穿透性创伤有所增加。本研究旨在对这些损伤进行特征描述，并评估在三级创伤中心接受治疗的患者的结局。
从瑞典斯德哥尔摩卡罗林斯卡大学医院（Karolinska University Hospital）2011 年至 2019 年期间收治的头部和颈部损伤患者的瑞典创伤登记处数据中提取资料。从医院记录中提取结局信息，主要结局集中在生理结局指标上，次要结局集中在手术和影像学结局上。
在 1436 例穿透性创伤患者中，确定了 329 例穿透性头颈部损伤患者。在这 329 例患者中，66 例（20%）为枪伤（GSW），240 例（73%）为刺伤（SW），23 例（7%）为其他创伤机制（OTM）所致损伤。相应的 3 组患者的中位年龄分别为 25、33 和 21 岁。主要受伤原因是袭击，54 例 GSW 患者（81.8%）和 158 例 SW 患者（65.8%）。GSW 患者的损伤更严重，入院时格拉斯哥昏迷评分、运动评分更差，且在受伤部位插管率更高。大多数 GSW 患者最初接受了主要手术（59.1%），更有可能发生颅内出血（21.2%）。GSW 的 30 天死亡率为 45.5%（n=30），SW 为 5.4%（n=13），OTM 为 0%（n=0）。GSW 和 SW 的发生率和死亡率呈逐年上升趋势。
2011 年至 2019 年期间，瑞典斯德哥尔摩穿透性头颈部创伤的发生率和死亡率呈逐年上升趋势。与 SW 和 OTM 患者相比，GSW 患者的损伤更严重，颅内出血更多，且接受了更多的手术干预。
