Ponzer S, Bergman B, Brismar B
Department of Orthopaedic Surgery, Stockholm Soder Hospital, Sweden.
Public Health. 1996 Jan;110(1):42-6. doi: 10.1016/s0033-3506(96)80034-5.
Civilian violence has become an increasing problem in the industrial world. Gunshot wounds, fatal or non-fatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm injuries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compared to a control group. The aim of this study was to determine the general morbidity in the same group of firearm victims. Our hypotheses were that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is raised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Sweden. The victims were compared with a sex- and age-matched control group. During the study period, 69.9% of the 820 firearm victims were treated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the latter on 1,512 occasions. The firearm injury group showed an higher morbidity in almost all diagnostic subgroups according to ICD-9. The trauma recurrence rate was high and suicide, homicide and assault were relatively more common in this group. We suggest that the gunshot episode may be regarded as one expression of a "chronic trauma syndrome'. Patients exhibiting this "syndrome' are characterized by recurrent episodes of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for society and their identification a matter of concern. It is probable that this "syndrome' also exists in other groups of trauma patients. Since hospitalization affords a unique opportunity of reaching patients who have a "chronic trauma syndrome' risk profile, we believe, that these patients should not only be treated for their acute injuries, but that they should be offered help in order to change their destructive life-style. Research should be undertaken to evaluate whether an intervention program, such as counseling, could have an effect on morbidity and injury recurrence for these patients.
在工业化国家，平民暴力已成为一个日益严重的问题。枪伤，无论致命与否，通常都被视为急性创伤事件。然而，我们之前基于820例火器伤的研究表明，与对照组相比，这组患者的特点是死亡率高且明显涉及犯罪行为。本研究的目的是确定同一组火器伤受害者的总体发病率。我们的假设是，这些患者因反复发生的创伤事件而消耗大量医院护理，且他们的总体发病率有所提高。收集了1972年至1992年瑞典斯德哥尔摩火器伤受害者所有住院护理事件的信息。将这些受害者与性别和年龄匹配的对照组进行比较。在研究期间，820名火器伤受害者中有69.9%因枪伤以外的其他原因接受治疗，而820名对照组患者中这一比例为45.5%。前一组住院3703次，后一组住院1512次。根据国际疾病分类第九版（ICD - 9），火器伤组在几乎所有诊断亚组中发病率都更高。创伤复发率很高，自杀、杀人及袭击在该组中相对更为常见。我们认为，枪击事件可被视为“慢性创伤综合征”的一种表现形式。表现出这种“综合征”的患者具有创伤反复发作、冒险和破坏性行为、高发病率和死亡率以及反社会特征。医疗、社会和法律并发症很常见，这使得这些患者对社会来说成本极高，对他们的识别也令人担忧。这种“综合征”很可能也存在于其他创伤患者群体中。由于住院为接触具有“慢性创伤综合征”风险特征的患者提供了独特机会，我们认为，这些患者不仅应接受急性损伤治疗，还应得到帮助以改变其破坏性行为方式。应该进行研究以评估诸如咨询等干预项目是否会对这些患者的发病率和损伤复发产生影响。
