National trends and resource associated with recurrent penetrating injury.

BACKGROUND: While recurrent penetrating trauma has been associated with long-term mortality and disability, national data on factors associated with reinjury remain limited. We examined temporal trends, patient characteristics, and resource utilization associated with repeat firearm-related or stab injuries across the US. METHODS: This was a retrospective study using 2010-2019 Nationwide Readmissions Database (NRD). NRD was queried to identify all hospitalizations for penetrating trauma. Recurrent penetrating injury (RPI) was defined as those returned for a subsequent penetrating injury within 60 days. We quantified injury severity using the International Classification of Diseases Trauma Mortality Prediction model. Trends in RPI, length of stay (LOS), hospitalization costs, and rate of non-home discharge were then analyzed. Multivariable regression models were developed to assess the association of RPI with outcomes of interest. RESULTS: Of an estimated 968,717 patients (28.4% Gunshot, 71.6% Stab), 2.1% experienced RPI within 60 days of the initial injury. From 2010 to 2019, recurrent gunshot wounds increased in annual incidence while that of stab cohort remained stable. Patients experiencing recurrent gunshot wounds were more often male (88.9 vs 87.0%, P<0.001), younger (30 [23-40] vs 32 [24-44] years, P<0.001), and less commonly insured by Medicare (6.5 vs 11.2%, P<0.001) compared to others. Those with recurrent stab wounds were younger (36 [27-49] vs 44 [30-57] years, P<0.001), less commonly insured by Medicare (21.3 vs 29.3%, P<0.001), and had lower Elixhauser Index Comorbidities score (2 [1-3] vs 3 [1-4], P<0.001) compared to others. After risk adjustment, RPI of both gunshot and stab was associated with significantly higher hospitalization costs, a shorter time before readmission, and increased odds of non-home discharge. CONCLUSION: The trend in RPI has been on the rise for the past decade. National efforts to improve post-discharge prevention and social support services for patients with penetrating trauma are warranted and may reduce the burden of RPI.

Application of 3D printing in assessment and demonstration of stab injuries.

In stabbing related fatalities, the forensic pathologist has to assess the direction of wound track (thus, the direction of the stabbing) and the weapon's possible characteristics by examining the stab wound. The determination of these characteristics can be made only with a high level of uncertainty, and the precise direction of the stabbing is often difficult to assess if only soft tissues are injured. Previously reported techniques used for the assessment of these wound characteristics have substantial limitations. This manuscript presents a method using today's easily accessible three-dimensional (3D) printing technology for blade-wound comparison and wound track determination. Scanning and 3D printing of knives is a useful method to identify weapons and determine the precise stabbing direction in a stabbing incident without compromising the trace evidence or the autopsy results. Ballistic gel experiment, and dynamic stabbing test experiments prove the method can be applied in safety, without compromising the autopsy results. Identification of the exact knife is not possible with complete certainty but excluding certain knives will decrease the number of necessary DNA examinations, hence it can lower the burden on forensic genetic laboratories. The method addresses many of the shortcomings of previously used methods of probe insertion or post-mortem CT. Insertion of the printed knife into the wound gives a good visual demonstration of the stabbing direction, thus easing the forensic reconstruction of the stabbing incident. After combining the 3D printing with photogrammetry, the achieved 3D visualization is useful for courtroom demonstration and educational purposes.

Penetrating injuries in Germany - epidemiology, management and outcome an analysis based on the TraumaRegister DGU®.

BACKGROUND: The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4-5 % of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. MATERIALS AND METHODS: Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. RESULTS: From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5 %, and 4333 patients with stab wounds (1.8 %), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41 % for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8 %). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3 % required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. CONCLUSIONS: In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.

Assessment of the knife penetration resistance of single and double-layer metal reinforced fabrics.

Textile structures are considered as the main component of protective clothing against the penetration of sharp objects. In the current research work, woven fabrics reinforced with metal threads as weft yarn were designed with various weave patterns including Twill, Satin, and Hopsack, and by using a weft-backed weaving structure. The mentioned reinforced samples were produced by altering the diameter and number of metal threads in each fabric structure. Assessment of fabric resistance against bending and sharp object penetration reveals that although the application of metal thread improves the fabric resistance against sharp object penetration, it leads to an increase in the fabric stiffness. According to the results, the influence of the number of metal threads on the penetration resistance was considerably higher than the metal thread diameter. However, more increase in the fabric's bending stiffness was observed with the rise of metal thread's diameter compared to the number of metal threads. According to the obtained outcomes, weave structure is an effective parameter that changes fabric's resistance against penetration. In this regard, weave patterns with more firmness that limit the yarn movement during the indentation of the sharp object present higher protection ability. Furthermore, the increment of fabric density enhances the resistance against penetration. In this study, the resistance of two-layer samples with various orientations angle of 0°/90° and -45°/+45° were probed, as well. Outcomes confirmed that two-layer samples resist better than single-layer sample against sharp object penetration due to the formation of a grid of metal threads. Among two studied fabrics' orientation angles, the sample with the angle of -45°/+45° presents greater penetration resistance.

[Forensic medical assessment of injuries caused by ice cracking tools]. / Sudebno-meditsinskaya otsenka povrezhdenii, prichinennykh orudiyami dlya kolki l'da.

The work purpose is to identify objective morphological traits of punctured and stab and slash wounds obtained as a result of using the ice cracking tools. An experimental injury to the skin was carried out, followed by the study and analysis of morphological signs of wounds. It was established that, depending on the design features of the ice-cracking tools and the conditions of injury, the injuries have a number of similar characteristics with wounds from the other puncturing and stab and slash articles, as well as they have certain morphological features.

[Tanatological assessment of long-brain structures in death from hemorrhagic shock at different post-mortal periods]. / Tanatologicheskaya otsenka struktur prodolgovatogo mozga pri smerti ot gemorragicheskogo shoka v razlichnye sroki postmortal'nogo perioda.

Authors determined the morphological and morphometric characteristics of nerve and vascular structures in death from blood loss complicated by hemorrhagic shock. The medulla oblongata of 12 corpses of persons who died from stab wounds of blood vessels and internal organs with sharp instruments at different times of the postmortem period was studied. Studies were carried out at stages of 6-8 hours, 12-14 hours, 18-20 hours, 24 hours or more of the postmortem period. It was found that as the interval after death from hemorrhagic shock increases, there is an increase in destructive changes, both neurons and intracerebral vessels in the medulla oblongata. Autolytic processes to a greater extent capture the intracerebral vessels comparing with neurons, which is more pronounced in the later stages of the study. The sizes of perineural and perivascular spaces in the dynamics of the postmortem period increase synchronously, which reflects the permanence of manifestations of tanatogenesis in different periods after death from hemorrhagic shock.

[Actualization of assessment of morphologic features of incisions and chop wounds of 'barrier' tissues of the head]. / Aktualizatsiia otsenki morfologicheskikh osobennostei rezanykh i rublenykh povrezhdenii 'bar'ernykh' tkanei golovy.

Aim of this study is to determine the influence of the basic conditions of the traumatic interaction of cutting and chopping objects with 'barrier' tissues of the scalp on the formation of morphological signs of damage. It was suggested to perform the comparative analysis of the morphological signs of incised and chopped scalp tissue wounds obtained by changing one given parameter in experimental damage modeling. The influence of the basic conditions of the traumatic interaction of cutting and chopping objects with the 'barrier' tissues of the scalp on the formation of morphological signs of the resulting damage was determined. The effectiveness of the proposed comparative analysis of morphological signs of incised and chopped lesions was confirmed.

Youth and Young Adult Victims of Interpersonal Violence at LA County + USC Medical Center: A Review of Epidemiology and Recidivism.

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism (P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.

Assessment of cases with sharp and penetrating object injuries.

BACKGROUND: Sharp and penetrating object injuries (SPOIs) are seen frequently in forensic medicine practice. In this study, we aimed to retrospectively investigate cases with SPOIs. MATERIALS AND METHODS: This study investigated the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with sharp object injuries were included in the study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury body site, suicide or homicide, radiologic findings, presence of vital danger, and severity of injury. RESULTS: In this study, we examined the charts for 934 inpatients with stab wounds. It was stated that 124 (13.27%) of those injured were female and 810 (86.63%) male; the average age of the injured persons was 29.8 ± 18.2 years. It was found that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). Also, 69.27% of the cases (n = 647) involved people less than 35 years of age. CONCLUSION: Considering that stab injuries are more frequent in the lower age groups, we believe that such injuries could be reduced by increasing training programs for young people.

Trauma Recidivism and Mortality Following Violent Injuries in Young Adults.

BACKGROUND: Trauma recidivism accounts for approximately 44% of emergency department admissions and remains a significant health burden with this patient cohort carrying higher rates of morbidity and mortality. METHODS: A level 1 trauma center registry was queried for patients aged 18-25 y presented between 2009 and 2015. Patients with nonaccidental gunshot wounds, stab wounds, or blunt assault-related injuries were categorized as violent injuries. Primary outcomes included mortality and recidivism, which were defined as patients with two unrelated traumas during the study period. Hospital records and the Social Security Death Index were used to aid in outcomes. RESULTS: A total of 6484 patients presented with 1215 (18.7%) sustaining violent injuries (87.4% male, median age 22.2 y). Mechanism of violent injuries included 64.4% gunshot wound, 21.1% stab, and 14.8% blunt assault. Compared with nonviolent injuries, violent injury patients had increased risk of mortality (9.3% versus 2.1%, P < 0.0001). Out-of-hospital mortality was 2.6% (versus 0.5% nonviolent, P < 0.0005), with an average time to death being 6.4 mo from initial injury. Recidivism was 24.9% with mean time to second violent injury at 31.9 ± 21.0 mo; 14.9% had two trauma readmissions, and 8.0% had ≥3. Ninety percent of subsequent injuries occurred within 5 y, with 19.1% in the first year. CONCLUSIONS: The burden of injury after violent trauma extends past discharge as patients have significantly higher mortality rates following hospital release. Over one-quarter present with a second unrelated trauma or death. Improved medical, psychological, and social collaborative treatment of these high-risk patients is needed to interrupt the cycle of violent injury.

Potential Use in Forensics of a Novel Hybrid Gelatin-Dynamic Impact Assessment.

Ballistic gelatin as simulant of the human body and organs is a support in forensics. After having obtained very good results for a new gelatin-based composite in terms of physicochemical and rheological properties, this study focused on this material's mechanical behavior during stabbing and shooting versus bovine and porcine organs and standard ballistic gelatin. The hybrid gelatin has a predominantly elastic behavior at 23°C, whereas the elastic modulus becomes practically constant in the 10-0.1 Hz frequency range. In terms of stabbing behavior, the small variations obtained between porcine organs and surrogate are below 5%, the perforation indicating a good similarity. From the ballistic test results using 10 × 28T rubber balls, it has been seen that the hybrid ballistic gelatin conducts to more reliable and reproducible values of perforation/penetration versus standard gelatin, making from it a real candidate for use in forensic tests.

Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services.

IMPORTANCE: Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. OBJECTIVE: To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle. MAIN OUTCOME AND MEASURE: In-hospital mortality. RESULTS: Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR, 0.45; 95% CI, 0.36-0.56) and stab wound (OR, 0.32; 95% CI, 0.20-0.52) subgroups. CONCLUSIONS AND RELEVANCE: Private vehicle transport is associated with a significantly lower likelihood of death when compared with ground EMS transport for individuals with gunshot wounds and stab wounds in urban US trauma systems. System-level evidence such as this can be a valuable tool for those responsible for developing and implementing policies at the trauma system level.

Selective non-operative management of abdominal stab wounds is a safe and cost effective strategy: A South African experience.

INTRODUCTION Selective non-operative management (SNOM) of abdominal stab wounds is well established in South Africa. SNOM reduces the morbidity associated with negative laparotomies while being safe. Despite steady advances in technology (including laparoscopy, computed tomography [CT] and point-of-care sonography), our approach has remained clinically driven. Assessments of financial implications are limited in the literature. The aim of this study was to review isolated penetrating abdominal trauma and analyse associated incurred expenses. METHODS Patients data across the Pietermaritzburg Metropolitan Trauma Service (PMTS) are captured prospectively into the regional electronic trauma registry. A bottom-up microcosting technique produced estimated average costs for our defined clinical protocols. RESULTS Between January 2012 and April 2015, 501 patients were treated for an isolated abdominal stab wound. Over one third (38%) were managed successfully with SNOM, 5% underwent a negative laparotomy and over half (57%) required a therapeutic laparotomy. Over five years, the PMTS can expect to spend a minimum of ZAR 20,479,800 (GBP 1,246,840) for isolated penetrating abdominal stab wounds alone. CONCLUSIONS Provided a stringent policy is followed, in carefully selected patients, SNOM is effective in detecting those who require further intervention. It minimises the risks associated with unnecessary surgical interventions. SNOM will continue to be clinically driven and promulgated in our environment.

Importance of diagnostic laparoscopy in the assessment of the diaphragm after left thoracoabdominal stab wound: A prospective cohort study.

BACKGROUND: Stab wounds in the left thoracoabdominal region may cause diaphragmatic injury. The aim of the present study was to determine incidence of diaphragmatic injury and role of diagnostic laparoscopy in detection of injury in patients with left thoracoabdominal stab wound. METHODS: Total of 81 patients (75 male, 6 female; mean age 27.5±9.8 years; range 14 to 60 years) who presented with left thoracoabdominal stab wound between April 2009 and September 2014 were evaluated. Laparotomy was performed on patients who had hemodynamic instability, signs of peritonitis, or organ evisceration. Remaining patients were followed conservatively. After 48 hours, diagnostic laparoscopy was performed on patients without laparotomy indication to examine the left diaphragm for injury. Follow-up and treatment findings were prospectively evaluated. RESULTS: Thirteen patients underwent laparotomy while diagnostic laparoscopy was performed on remaining 68 patients. Left diaphragmatic injury was observed in 19 patients (23.5%) in the study group. Four injuries were diagnosed by laparotomy and 15 were diagnosed by laparoscopy. Presence of hemopneumothorax did not yield difference in incidence of diaphragmatic injury (p=0.131). No significant difference was detected in terms of diaphragmatic injury with respect to entry site of stab wound in the thoracoabdominal region (p=0.929). CONCLUSION: It is important to evaluate the diaphragm in left thoracoabdominal stab injuries, and diagnostic laparoscopy is still the safest and most feasible method.

Prevalence, management and outcome of traumatic diaphragm injuries managed by the Pietermaritzburg Metropolitan Trauma Service.

INTRODUCTION This audit of traumatic diaphram injury (TDI) from a busy South African trauma service reviews the spectrum of disease and highlights current approaches to these injuries. METHODS The Pietermaritzburg Metropolitan Trauma Service (PMTS) has maintained an Electronic Surgical Registry (ESR) and a Hybrid Electronic Medical Record (HEMR) system since January 1st 2012. RESULTS A total of 105 TDIs were identified and repaired during the study period. The mean patient age was 30 years (range 15-68 years - SD 9.7). The majority (92.4%) of patients were male (97/105). Penetrating trauma was the leading mechanism of injury (94%). 75 patients sustained a TDI from a stab wound, and the remaining 24 injuries resulted from gunshot wounds. Multiple associated injuries and high morbidity was seen with right diaphragm injury, blunt trauma, gunshot wounds and chronic diaphragmatic hernias. CONCLUSIONS TDI is a fairly uncommon injury with a local incidence of 1.6%. It presents in a spectrum from the obvious to the occult. Multiple associated injuries and high morbidity occur following blunt trauma or gunshot wounds, right diaphragm injury and chronic diaphragmatic hernias. Diagnostic laparoscopy offers a diagnostic and therapeutic tool to prevent progression of occult TDI to chronic diaphragmatic hernias.

Feasibility of selective non-operative management for penetrating abdominal trauma in France.

INTRODUCTION: In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds. The aim of our study was to evaluate the feasibility of NOM for the treatment of penetrating abdominal traumas at 3 hospitals in the Southeast of France. METHODOLOGY: Our study was multicentric and retroprospective from January, 2010 to September, 2013. Patients presenting with a penetrating abdominal stab wound (SW) or gunshot wound (GSW) were included in the study. Those with signs of acute abdomen or hemodynamic instability had immediate surgery. Patients who were hemodynamically stable had a CT scan with contrast. If no intra-abdominal injury requiring surgery was evident, patients were observed. Criteria evaluated were failed NOM and its morbidity, rate of non-therapeutic procedures (NTP) and their morbidity, length of hospital stay and cost analysis. RESULTS: One hundred patients were included in the study. One patient died at admission. Twenty-seven were selected for NOM (20 SW and 7 GSW). Morbidity rate was 18%. Failure rate was 7.4% (2 patients) and there were no mortality. Seventy-two patients required operation of which 22 were NTP. In this sub-group, the morbidity rate was 9%. There were no mortality. Median length of hospital stay was 4 days for the NOM group and 5.5 days for group requiring surgery. Cost analysis showed an economic advantage to NOM. CONCLUSION: Implementation of NOM of penetrating trauma is feasible and safe in France. Indications may be extended even for some GSW. Clinical criteria are clearly defined but CT scan criteria should be better described to improve patient selection. NOM reduced costs and length of hospital stay.

Evaluación de criterios para laparotomía en lesiones abdominales por arma blanca / Laparotomy criteria assessment in abdominal stab wounds

Introducción: las lesiones traumáticas penetrantes del abdomen involucran usualmente la violación de la cavidad abdominal por una herida realizada con arma blanca u otro tipo de objeto cortopunzante. Esto constituye un problema de salud y uno de los motivos de urgencia, más comunes en la consulta de cirugía. En Cuba, los accidentes donde se incluyen este tipo de lesiones constituyeron la quinta causa de defunciones, en ambos sexos, en el año 2014. Objetivo: evaluar los criterios indicativos de laparotomía en pacientes con heridas abdominales por arma blanca. Método: se realizó un estudio de evaluación de medios diagnósticos en pacientes sometidos a una laparotomía exploratoria por herida abdominal con arma blanca. La población estuvo constituida por todos los pacientes con este tipo de lesión y la muestra por los intervenidos quirúrgicamente. Se evaluaron diversos elementos clínicos y complementarios indicativos de laparotomía ante la posibilidad de lesión orgánica significativa. Resultados: la edad promedio fue de 32 años; predominó el sexo masculino (91,3 por ciento). De los pacientes, 41,3 por ciento se presentaron signos de intoxicación exógena, y 51,25 por ciento de las laparotomías fueron terapéuticas. Mostraron mejores resultados de sensibilidad, especificidad y valores predictivos positivos la presencia de choque hipovolémico (84,2 por ciento), signos clínicos de hemorragia continua (82,4 por ciento) y perforación obvia del tracto gastrointestinal (90,9 por ciento). Entre los complementarios la laparoscopia mostró valores de sensibilidad (89,5 por ciento) y especificidad (81,8 por ciento) superior al resto. Conclusiones: el choque hipovolémico, los signos de hemorragia continua, signos de perforación obvia del tracto gastrointestinal, y la laparoscopia revelaron los mejores resultados como criterios indicativos de laparotomía en heridas abdominales por arma blanca(AU)

Introduction: penetrating traumatic lesions of the abdomen usually leads to damage in the abdominal cavity from a wound caused with a white weapon or other sharp-piercing object. This circumstance constitutes a health problem and one of the most common reasons for emergency consultation in surgery. This type of lesions was the fifth leading cause of death for both sexes in Cuba in 2014. Objective: to evaluate the criteria indicative of laparotomy in patients with abdominal wounds caused with a white weapon. Method: a diagnostic modalities assessment study was carried out in patients who underwent exploratory laparotomy for abdominal wound caused by a white weapon. The target group was made up by the patients with this type of lesions. The sample consisted of surgery patients (n= 80). Several clinical and complementary elements indicative of laparotomy were assessed before the possibility of significant organic lesions. Results: the average age was 32 years, with a predominance of males (91.3 percent). 41.3 percent of the patients showed exogenous intoxication signs, only 51.25 percent of laparotomies were therapeutic ones. The presence of hypovolemic shock (84.2 percent), clinical signs of ongoing bleeding (82.4 percent) and obvious gastrointestinal tract perforation (90.9 percent) showed better sensitivity, specificity and positive predictive values. Among the complementary tests, laparoscopy showed values of sensitivity (89.5 percent) and specificity (81.8 percent) higher than the others. Conclusions: hypovolemic shock, signs of ongoing bleeding and signs of obvious gastrointestinal tract perforation, and laparoscopy showed the best results as criteria indicative of laparotomy in abdominal stab wounds(AU)

Analytical assessment of woven fabrics under vertical stabbing - The role of protective clothing.

Knives are being used more commonly in street fights and muggings. Therefore, this work presents an analytical model for woven fabrics under vertical stabbing loads. The model is based on energy method and the fabric is assumed to be unidirectional comprised of N layers. Thus, the ultimate stab resistance of fabric was determined based on structural parameters of fabric and geometrical characteristics of blade. Moreover, protective clothing is nowadays considered as a strategic branch in technical textile industry. The main idea of the present work is improving the stab resistance of woven textiles by using metal coating method. In the final, a series of vertical stabbing tests were conducted on cotton, polyester and polyamide fabrics. Consequently, it was found that the model predicts with a good accuracy the ultimate stab resistance of the sample fabrics.

Dispositivos de segurança em instrumentos perfurocortantes versus acidentes com exposição a material biológico / Safety-engineered sharp devices versus accidents with exposure to biological material / Dispositivos de seguridad en instrumentos cortopunzantes versus accidentes con exposición a material biológico

Objetivou-se analisar, a partir da literatura, a relação entre a incorporação de dispositivos de segurança em instrumentos perfurocortantes e a ocorrência de acidentes de trabalho com o uso desses instrumentos, envolvendo profissionais da área da saúde. Trata-se de uma revisão integrativa, realizada nos bancos de dados Scientific Eletronic Library Online e Biblioteca Virtual em Saúde, cujos descritores foram segurança de equipamentos, gestão de risco, prevenção de acidentes, exposição a agentes biológicos e pessoal de saúde. Como resultado, foram encontrados 14 artigos, publicados no período de 2006 a 2014, os quais foram discutidos em duas categorias: dispositivo de segurança em instrumentos perfurocortantes e acidentes utilizando instrumentos perfurocortantes com e sem dispositivo de segurança. Conclui-se que a incorporação de dispositivos de segurança em instrumentos perfurocortantes proporciona redução de acidentes relacionados à exposição a material biológico; favorece economicamente a instituição; promove a segurança e a saúde dos trabalhadores e, consequentemente, melhora a qualidade da assistência prestada aos clientes.

This integrative literature review, to examine the relationship between safety engineering of sharp devices and the occurrence of accidents among health care professionals using these devices, was conducted on the Scientific Electronic Library Online and Virtual Health Library databases, with the descriptors [in Portuguese] equipment safety, risk management, accident prevention, exposure to biological agents, and health personnel. The 14 articles found as a result were discussed in two categories: safety engineering on sharp devices, and accidents using sharp devices with and without safety engineering. It was concluded that safety engineering on sharp devices has yielded a reduction in accidents involving exposure to biological material; favors the institution economically; promotes workers' health and safety and, consequently, improves the quality of client care.

Este estudio tuvo como objetivo analizar la relación entre la incorporación de dispositivos de seguridad en instrumentos cortopunzantes y la ocurrencia de accidentes laborales al usar estos instrumentos, con la participación de profesionales de la salud, a partir de la literatura. Se trata de una revisión integradora de literatura realizada en los bancos de datos Scientific Eletronic Library Online y Biblioteca Virtual em Saúde, cuyos descriptores fueron seguridad de equipos, gestión de riesgos, prevención de accidentes, exposición a agentes biológicos y personal de salud. Como resultado, se encontraron 14 artículos, publicados en el periodo de 2006 a 2014, que fueron discutidos en dos categorías: dispositivos de seguridad en instrumentos cortopunzantes, y accidentes utilizando instrumentos cortopunzantes con y sin dispositivos de seguridad. Se concluye que la incorporación de dispositivos de seguridad en instrumentos cortopunzantes proporciona una reducción de accidentes relacionados con la exposición a material biológico; favorece económicamente la institución; promueve la seguridad y la salud de los trabajadores y, consecuentemente, mejora la calidad de la asistencia proporcionada a los clientes.

[The possibilities for the medical assessment of the injuries inflicted by the darts fired from the pneumatic rifles].

This article reports the results of analysis of the data borrowed from the special literature. They demonstrate the absence of objective forensic medical evidence needed to diagnose injuries to the human body and clothes inflicted by the darts fired from the pneumatic rifles. Meanwhile, the use of the darts differing in the design parameters has the significant influence on the morphological features of the resulting injuries. The knowledge of the dart characteristics creates the prerequisites for the differentiation between the injuries caused by these missile weapons and other metallic objects.