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1.
PLoS One ; 18(11): e0280702, 2023.
Article in English | MEDLINE | ID: mdl-37967100

ABSTRACT

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.


Subject(s)
Wounds, Gunshot , Wounds, Penetrating , Wounds, Stab , Humans , Male , Aged , United States/epidemiology , Wounds, Gunshot/epidemiology , Retrospective Studies , Aftercare , Patient Discharge , Medicare , Wounds, Penetrating/epidemiology , Wounds, Stab/epidemiology , Injury Severity Score
2.
BMJ Open ; 13(10): e071873, 2023 10 28.
Article in English | MEDLINE | ID: mdl-37898492

ABSTRACT

BACKGROUND: Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating injury in Japan. This prevents the development of effective strategies for trauma care in patients with penetrating injury. METHODS: This retrospective cohort study investigated 313 643 patients registered in the Japan Trauma Data Bank (JTDB) dataset between 1 January 2009 and 31 March 2018. The inclusion criteria comprised patients with penetrating injuries transferred from the injury site by emergency vehicles. Moreover, the patients registered in the JTDB dataset were included in this study regardless of age and sex. Outcomes measured were nationwide trends of characteristics, in-hospital mortality and in-hospital mortality risk among Japanese patients with penetrating injury. The mortality risk was analysed by hospital admission year, age, Injury Severity Score (ISS) and emergency procedures. RESULTS: Overall, 7132 patients were included. Median age significantly increased during the 10-year study periods (from 48 to 54 years, p=0.002). Trends for the mechanism of injury did not change; the leading cause of penetrating injury was stab wounds (SW: 76%-82%). Overall, the in-hospital mortality rate significantly decreased (4.0% to 1.7%, p=0.008). However, no significant improvement was observed in the in-hospital mortality trend in all ISS groups with SW and active bleeding. Patients with active bleeding who underwent urgent transcatheter arterial embolization had significantly lower mortality risk (p=0.043, OR=0.12, 95% CI=0.017 to 0.936). Conversely, the surgical procedure for haemostasis did not improve the mortality risk of patients with SW and active bleeding. CONCLUSION: The severity-adjusted mortality trend in patients with penetrating injuries did not improve. Moreover, patients with active bleeding who underwent urgent surgical procedure for haemostasis had a higher mortality risk.


Subject(s)
Wounds, Penetrating , Wounds, Stab , Humans , East Asian People , Incidence , Injury Severity Score , Retrospective Studies , Wounds, Penetrating/epidemiology , Wounds, Penetrating/surgery , Wounds, Stab/epidemiology , Middle Aged , Japan/epidemiology
3.
S Afr J Surg ; 61(3): 17-20, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37791709

ABSTRACT

BACKGROUND: Selective non-operative management (SNOM) is the current gold standard for the treatment of patients with penetrating neck trauma. The policy revolves around the liberal use of computed tomography angiography (CTA) in those patients who are haemodynamically stable, irrespective of the anatomical zone of injury, aiming at reducing the incidence of negative and non-therapeutic interventions and their potential complications. METHODS: A retrospective audit of results of patients who underwent immediate surgical exploration at the Chris Hani Baragwanath Academic Hospital in Soweto between January 2010 and December 2015 was performed. RESULTS: One-hundred and forty-five (145) patients, with a median age of 28 years (range 18-67 years), predominantly males (93.8%), underwent immediate exploration. Most injuries were caused by stab wounds (92.4%) and affected zone 2 (54.1%) on the left side of the neck (69.6%). The most common presentations were active haemorrhage (29.4%), shock (24.1%) and expanding haematoma (15.1%). A major vascular injury was found in 40%, and aero-digestive organ injury in 19.3%. The rate of negative-non-therapeutic exploration in this cohort was 4.1%. Complications were recorded in 7.6%, and the overall mortality was 9.6% secondary to early uncontrolled haemorrhage, sepsis and occlusive strokes. CONCLUSIONS: The utilisation of SNOM with strict criteria for selection of patients who require immediate surgical exploration versus investigations with CTA results in a low rate of non-therapeutic interventions.


Subject(s)
Neck Injuries , Vascular System Injuries , Wounds, Penetrating , Wounds, Stab , Male , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Female , Retrospective Studies , South Africa/epidemiology , Neck Injuries/diagnostic imaging , Neck Injuries/surgery , Neck Injuries/epidemiology , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgery , Wounds, Stab/diagnostic imaging , Wounds, Stab/surgery , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/surgery , Hemorrhage
4.
Ulus Travma Acil Cerrahi Derg ; 29(9): 1026-1031, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37681725

ABSTRACT

BACKGROUND: The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases. METHODS: We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups. RESULTS: Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36-83.71%), and a specificity of 100% (95% CI 82.35-100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries. CONCLUSION: Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.


Subject(s)
Laparoscopy , Thoracic Injuries , Wounds, Penetrating , Wounds, Stab , Humans , Retrospective Studies , Wounds, Stab/diagnostic imaging , Wounds, Stab/surgery , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgery , Thoracic Injuries/diagnostic imaging , Thoracic Injuries/surgery
6.
San Salvador; MINSAL; ago. 07, 2023. 2 p.
Non-conventional in Spanish | BISSAL, LILACS | ID: biblio-1444045

ABSTRACT

Resumen de eventos de notificación hasta SE 30/2023. Informe Epidemiológico de vigilancia intensificada. 2022-2023. Eventos de notificación intensificada diaria y acumulado. Atenciones, consultas médicas, referencias y emergencias acumuladas 2022-2023. Informe de atenciones, consultas médicas, emergencias y referencias


Summary of notification events up to SE 30/2023. Epidemiological report of intensified surveillance. 2022-2023. Daily and cumulative intensified notification events. Attentions, medical consultations, referrals and cumulative emergencies 2022-2023. Report of care, medical consultations, emergencies and references


Subject(s)
Wounds, Stab , Accidents, Traffic , Communicable Diseases , Electronic Publications , Foodborne Diseases , El Salvador
7.
J Vasc Surg ; 78(4): 920-928, 2023 10.
Article in English | MEDLINE | ID: mdl-37379894

ABSTRACT

OBJECTIVE: Penetrating carotid artery injuries (PCAI) are significantly morbid and deadly, often presenting in extremis with associated injuries and central nervous system deficit. Repair may be challenging with arterial reconstruction vs ligation role poorly defined. This study evaluated contemporary outcomes and management of PCAI. METHODS: PCAI patients in the National Trauma Data Bank from 2007 to 2018 were analyzed. Outcomes were compared between repair and ligation groups after additionally excluding external carotid injuries, concomitant jugular vein injuries, and head/spine Abbreviated Injury Severity score of ≥3. Primary end points were in-hospital mortality and stroke. Secondary end points were associated injury frequency and operative management. RESULTS: There were 4723 PCAI (55.7% gunshot wounds, 44.1% stab wounds). Gunshot wounds more frequently had associated brain (73.8% vs 19.7%; P < .001) and spinal cord (7.6% vs 1.2%; P < .001) injuries; stab wounds more frequently had jugular vein injuries (19.7% vs 29.3%; P < .001). The overall in-hospital mortality was 21.9% and the stroke rate was 6.2%. After exclusion criteria, 239 patients underwent ligation and 483 surgical repair. Ligation patients had lower presenting Glasgow Coma Scale (GCS) than repair patients (13 vs 15; P = .010). Stroke rates were equivalent (10.9% vs 9.3%; P = .507); however, in-hospital mortality was higher after ligation (19.7% vs 8.7%; P < .001). In-hospital mortality was higher in ligated common carotid artery injuries (21.3% vs 11.6%; P = .028) and internal carotid artery injuries (24.5% vs 7.3%; P = .005) compared with repair. On multivariable analysis, ligation was associated with in-hospital mortality, but not with stroke. A history of neurological deficit before injury lower GCS, and higher Injury Severity Score (ISS) were associated with stroke; ligation, hypotension, higher ISS, lower GCS, and cardiac arrest were associated with in-hospital mortality. CONCLUSIONS: PCAI are associated with a 22% rate of in-hospital mortality and a 6% rate of stroke. In this study, carotid repair was not associated with a decreased stroke rate, but did have improved mortality outcomes compared with ligation. The only factors associated with postoperative stroke were low GCS, high ISS, and a history of neurological deficit before injury. Beside ligation, low GCS, high ISS, and postoperative cardiac arrest were associated with in-hospital mortality.


Subject(s)
Carotid Artery Injuries , Stroke , Wounds, Gunshot , Wounds, Penetrating , Wounds, Stab , Humans , Wounds, Gunshot/surgery , Carotid Artery Injuries/epidemiology , Carotid Artery Injuries/surgery , Stroke/epidemiology , Wounds, Penetrating/epidemiology , Wounds, Penetrating/surgery , Wounds, Penetrating/complications , Wounds, Stab/diagnosis , Wounds, Stab/epidemiology , Wounds, Stab/surgery , Retrospective Studies
8.
J Forensic Sci ; 68(4): 1218-1227, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37306358

ABSTRACT

Estimating the applied power during a stabbing incident, or estimating the minimal force necessary to penetrate the body with a certain weapon is a challenging task in forensic practice. A thorough forensic evaluation of stabbing forces needs objective numerical experimental data. Stabbing tests of 12 different weapons - including knives, a pair of scissors, a fork, screwdrivers, a rasp, a corkscrew, and a utility knife blade - were performed with a Mecmesin MultiTest-dV material tester on pork loin and ballistic gel to estimate the stabbing forces and dynamics. Penetration force (Fp ) and maximal force (Fmax ) were recorded, and the registered force curves were analyzed. Fmax was 159.8-212.07 Newton (N), 30.56-30.58 N, 168.9-185.48 N for various knives; 171.39-190.43 N for the pair of scissors, 233.6 N for the fork; 532.65-562.65 N, 370.31-367.19 N and 314.51-432.89 N for various screwdrivers, 44.14-56.62 N for utility knife during pork loin stabbing. The butter knife, corkscrew and rasp were not able to penetrate the pork loin, and the curved fork bent during stabbing. The results prove that weapon characteristics greatly influence the force necessary for penetration. Maximal stabbing force depends mostly on tip sharpness, and the force sharply decreases after penetration occurs, which indicates that edge sharpness is not as important as tip characteristics during stabbing perpendicular to skin surface. The penetration force during stabbing with a pair of scissors is comparable to the penetration force of knives. Stabbing with screwdrivers generally needs larger force than average knives but depends greatly on screwdriver size.


Subject(s)
Wounds, Stab , Humans , Forensic Medicine , Weapons , Household Products
10.
Article in German | MEDLINE | ID: mdl-37044109

ABSTRACT

The acute medical care in Germany after gunshot and stab wounds in the pre-hospital and in-hospital setting is a rarity in an international comparison. The resulting lack of routine in the acute care of critically injured people after penetrating trauma should therefore be countered with regular theoretical and practical training. In addition to standardized care algorithms for the care of severely injured people, knowledge of kinetics and wound ballistics is required for focused treatment. The article focuses mainly on the early treatment phase.


Subject(s)
Wounds, Gunshot , Wounds, Penetrating , Wounds, Stab , Humans , Wounds, Gunshot/surgery , Wounds, Penetrating/surgery , Wounds, Stab/diagnosis , Wounds, Stab/surgery , Hospitals , Germany , Retrospective Studies
11.
Am Surg ; 89(8): 3568-3569, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36913718

ABSTRACT

Penetrating neck trauma poses a significant risk to multiple vital structures, which if not treated immediately may lead to devastating consequences. Our patient presented after sustaining self-inflicted stab wounds to the neck. He was taken to the operating room for a left neck exploration and median sternotomy, revealing a distal tracheal injury. Following repair of the tracheal injury, an intraoperative esophagogastroduodenoscopy demonstrated a full-thickness esophageal injury 15 cm proximal to the tracheal injury. Both injuries were the result of separate stab entries originating from the same external midline wound. To our knowledge, this case report is unique in bringing this circumstance to the literature, demonstrating the importance of full intraoperative examination to assess for concomitant wounds in stab injuries after the initial pathology has been found and the initial stab trajectory understood.


Subject(s)
Neck Injuries , Wounds, Penetrating , Wounds, Stab , Male , Humans , Trachea/injuries , Wounds, Penetrating/surgery , Esophagus/diagnostic imaging , Esophagus/surgery , Esophagus/injuries , Wounds, Stab/diagnostic imaging , Wounds, Stab/surgery , Neck , Neck Injuries/surgery , Neck Injuries/diagnosis
12.
Clin Ter ; 174(2): 109-114, 2023.
Article in English | MEDLINE | ID: mdl-36920125

ABSTRACT

Background: As sharp force injury accounts for 10-20% of clinical forensic examinations, forensic pathologists are often asked to investigate deceased victims of stab wounds. Moreover, homicide by sharp force (stabbing) is one of the most common in European countries, involving generally domestic or interpersonal conflict. Stabbing as a suicide method constitutes a low percentage of all suicides, 2% to 3%. Accidental death due to sharp force is even rarer (0-3%) and usu-ally caused by an impact or a fall into different type of glass surface. Death due to stabbing is usually caused by exsanguinating incisions to organs or large blood vessels (such as arteries), leading to haemor-rhagic shock. Penetrating artery injuries are well known in clinical settings, and extremities are the most common sites of such injuries. Indeed, 50% to 60% of injuries occur in femoral or popliteal arteries, 30% in brachial artery. Aims: The aim of this paper is to present two rare cases of sharp force fatality, showing how a thorough forensic pathology methodology, including death scene investigation, autopsy examination, and toxicological analyses, are pivotal to detect the manner of death. Case Reports: This paper presents two peculiar cases of sharp force fatalities: the first, a single and accidental stab injury on the right armpit which caused a complete transection of the axillary artery; the second, a single homicidal stab wound on the lower leg causing a full-thickness lesion of the anterior tibial artery.


Subject(s)
Suicide , Wounds, Stab , Humans , Homicide , Wounds, Stab/pathology , Accidents , Arteries/pathology
13.
World J Surg ; 47(6): 1457-1463, 2023 06.
Article in English | MEDLINE | ID: mdl-36859569

ABSTRACT

BACKGROUND: In penetrating abdominal trauma, computed tomography (CT) is routinely performed to evaluate stable patients for selective non-operative management (SNOM). Triple-contrast CT (oral, rectal, and IV) has traditionally been used. However, due to its disadvantages, most trauma centres, including our unit at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), now perform single-contrast intravenous-only CT scans. We performed a retrospective review to determine the accuracy of single-contrast CT scans for detecting hollow viscus injuries (HVI) in penetrating abdominal trauma. METHODS: A retrospective review of all patients who presented to CMJAH with penetrating abdominal injuries was performed between 01 August 2017 and 31 August 2019 and were evaluated for SNOM with CT (IV contrast only). Patient records were reviewed to determine pertinent demographics, mechanism, and site of injury, as well as metabolic parameters. CT findings were compared to findings at laparotomy. RESULTS: A total of 437 patients met the inclusion criteria. The majority were male (92.7%), with a mean age of 31.5 yrs (SD 8.7). Injuries were predominantly due to stab wounds (72,5%, n = 317). CT scan was negative in 342 patients, of which 314 completed SNOM successfully. A total of 93 patients proceeded to laparotomy. CT had a sensitivity of 95.1%, specificity of 44.2%, positive predictive value of 57.4%, and negative predictive value of 92%. CONCLUSION: Single-contrast CT in penetrating abdominal trauma is a valuable investigative tool in identifying patients for SNOM. Features of HVI on single-contrast CT are not very specific and should be interpreted along with other clinical factors including wound trajectory and serial abdominal examinations. Other associated injuries such as diaphragmatic and solid organ injuries should be considered in the final management plan.


Subject(s)
Abdominal Injuries , Wounds, Penetrating , Wounds, Stab , Humans , Male , Female , Adult , South Africa , Tomography, X-Ray Computed/methods , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgery , Wounds, Stab/surgery , Abdominal Injuries/diagnostic imaging , Abdominal Injuries/surgery , Retrospective Studies , Laparotomy
14.
Int J Legal Med ; 137(5): 1555-1567, 2023 Sep.
Article in English | MEDLINE | ID: mdl-36763161

ABSTRACT

The aim of this article is to provide a scientific and statistical basis to identify the murder weapon in stabbing cases from the geometric characteristics of the stab-marks left on human ribs. For this purpose, a quantitative predictive model is developed, based on geometric measurements of the stab-mark and its location along the rib. A general method based on Bayesian inference and probabilities is used for the model development, rather than a deterministic model given its inability in certain occasions to identify the murder weapon. Following the process explained in this article to collect the stab-mark information required, the complete probabilistic model exposed attained a high accuracy in the identification of the murder weapon between two macroscopically identical blades with a microscopic alteration in one of them (more than 90% of correct identification is achieved).


Subject(s)
Wounds, Stab , Humans , Bayes Theorem , Ribs/injuries , Weapons , Homicide
15.
Injury ; 54(5): 1349-1355, 2023 May.
Article in English | MEDLINE | ID: mdl-36764901

ABSTRACT

BACKGROUND: Penetrating cardiac injuries (PCI) are often fatal despite rapid transport and treatment in the prehospital setting. Although many studies have identified risk factors for mortality, few studies have included non-transported field mortalities. This study analyzes penetrating cardiac injuries including hospital and coroner reports in the current era. METHODS: Seventeen years of data were reviewed, including the trauma center (TC) registry, medical records, and coroner reports from 2000-2016. PCI were graded using American Association for the Surgery of Trauma (AAST) cardiac organ injury score (COIS). Subjects were divided into three groups: field deaths, hospital deaths, and survivors to hospital discharge. The primary outcome is survival to hospital discharge overall and among those transported to the hospital. RESULTS: During the study period, 643 PCI patients were identified, with 52 excluded for inadequate data, leaving 591 for analysis. Mean age was 38.1 ± 17.5 years, and survivors (n=66) were significantly younger than field deaths (n=359) (32.6 ± 14.4 vs 41.1 ± 18.5, p<0.001). Stab wounds had higher survival than gunshot wounds (26.6% vs. 4.3%, p<0.001). COIS grades 4 to 6 (n=602) had lower survival than grades 1 to 3 (n=41) (8.3% vs. 39.0%, p<0.001). Survivors (n=66) had lower median COIS than patients who died in hospital (n=218) (4 vs. 5, p<0.001). Single chamber PCI had higher survival than multiple chamber PCI (13% vs. 5%, p=0.004).  The left ventricle is the most injured (n=177), and right ventricle PCI has the highest survival (p<0.001).  Of field deaths, left ventricular injuries had the highest single chamber mortality (60%), equaling multi-chamber PCI (60%). CONCLUSIONS: Survival to both TC evaluation and hospital discharge following PCI is influenced by many factors including age, mechanism, anatomic site, and grade. Despite advances in trauma care, survival has not appreciably improved.


Subject(s)
Heart Injuries , Wounds, Gunshot , Wounds, Penetrating , Wounds, Stab , Humans , Young Adult , Adult , Middle Aged , Heart Injuries/surgery , Hospitals , Retrospective Studies
16.
Injury ; 54(5): 1386-1391, 2023 May.
Article in English | MEDLINE | ID: mdl-36604289

ABSTRACT

BACKGROUND: Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ. METHODS: A five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021. RESULTS: 214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n = 81) and the chest/thorax (n = 77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n = 8), colon (n = 5) and stomach (n = 2), whilst the liver was the most frequently injured solid organ (n = 6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths. CONCLUSION: Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.


Subject(s)
Abdominal Injuries , Wounds, Stab , Humans , Queensland/epidemiology , Retrospective Studies , Abdominal Injuries/epidemiology , Abdominal Injuries/surgery , Wounds, Stab/epidemiology , Wounds, Stab/surgery , Demography
17.
Sci Justice ; 63(1): 63-73, 2023 01.
Article in English | MEDLINE | ID: mdl-36631183

ABSTRACT

Dehydration is a taphonomic process that affects nearly all skeletal remains, yet there is a dearth of evidence on this process within the forensic taphonomy literature. When considering the forensic implications of skeletal dehydration, a particular area of concern is sharp force trauma due to its global prominence in forensic cases. In an attempt to address these literature gaps and quantify the effects that dehydration has on skeletal elements, a controlled experiment subjected Sus domesticus (i.e., domestic pig) radii samples (n = 36) to laboratory-induced dehydration after they were inflicted with knife trauma. All samples were photographed pre- and post-dehydration; bone section and kerf mark length, width, and area were then measured from these photographs using ImageJ. Statistical analysis of pre- and post-dehydration samples showed that all measurements experienced significant (p ≤ 0.001) shrinkage, with bone sample area shrinking an average of 8.8 % and kerf mark area an average of 29.7 %. Alterations in length, width and area between the kerf marks and bone samples showed a weak, moderate, and strong correlation, respectively. These findings suggest that anthropological analysis may be affected by dehydration-induced shrinkage, highlighting the necessity of continued research into the effects of dehydration on skeletal trauma.


Subject(s)
Dehydration , Wounds, Stab , Swine , Animals , Body Remains , Bone and Bones , Sus scrofa , Forensic Anthropology
18.
Hosp Pediatr ; 13(2): 153-158, 2023 02 01.
Article in English | MEDLINE | ID: mdl-36597702

ABSTRACT

BACKGROUND: Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. OBJECTIVE: To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. METHODS: This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. RESULTS: A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. CONCLUSION: A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.


Subject(s)
Reinjuries , Wounds and Injuries , Wounds, Gunshot , Wounds, Stab , Humans , Child , Male , Adolescent , Young Adult , Adult , Wounds, Gunshot/prevention & control , Retrospective Studies , Cohort Studies , Aftercare , Patient Discharge , Violence/prevention & control , Wounds, Stab/epidemiology , Wounds, Stab/prevention & control , Hospitals , Wounds and Injuries/epidemiology , Wounds and Injuries/prevention & control
19.
World J Surg ; 47(4): 863-869, 2023 04.
Article in English | MEDLINE | ID: mdl-36581690

ABSTRACT

BACKGROUND: Gunshot wounds to the heart are regarded as one of the most lethal penetrating injuries. There has been an increase in gunshot wounds to the chest in our institution in recent years. Injuries to the heart caused by gunshot wounds can be challenging, with patients arriving in hospital in different physiological states. We report our trauma unit's experience with civilian gunshot wounds to the heart. METHODS: A retrospective review from January 2005 till December 2018 of those 18 years of age and above who presented to our hospital with penetrating cardiac injuries over eight years was done. Those who presented with a carotid pulse and a cardiac rhythm were included in the study. Blood pressure of less than 90 mmHg was considered as haemodynamic instability. Demographics, physiological parameters, injuries sustained, preferred surgical access to the chest, and type of surgery were analysed. The complications during their hospital stay and outpatient clinic were documented. The incidences of in-hospital mortality were also noted. Descriptive statistics with STATA version 15 were conducted. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 37 patients were enroled in the study; four were excluded for incomplete data. All presented directly from the scene, with a median age of 30 (IQR 24-36). Haemodynamic instability was in 64% of the cases. The most common injured chamber was the right ventricle (75.7%). There were only two complications recorded; local wound sepsis and empyema. All survivors received a post-surgical echocardiogram. The overall survival rate was 18.9% (n = 7). Of the ten that required emergency room thoracotomy, only one survived to discharge. CONCLUSION: Gunshot wounds to the heart have a mortality rate greater than 80% in those arriving alive. Only one in ten of those who meet the strict criteria for emergency room thoracotomy survive hospitalisation. The local complication rate was low.


Subject(s)
Heart Injuries , Thoracic Injuries , Wounds, Gunshot , Wounds, Penetrating , Wounds, Stab , Humans , Wounds, Gunshot/epidemiology , Wounds, Gunshot/surgery , Wounds, Gunshot/complications , Wounds, Stab/surgery , South Africa/epidemiology , Heart Injuries/epidemiology , Heart Injuries/surgery , Wounds, Penetrating/surgery , Thoracic Injuries/epidemiology , Thoracotomy , Retrospective Studies , Trauma Centers
20.
J Ayub Med Coll Abbottabad ; 34(Suppl 1)(4): S1040-S1042, 2022.
Article in English | MEDLINE | ID: mdl-36550672

ABSTRACT

Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We present a case of a fortunate survivor who had complete transection of left anterior descending (LAD) artery with right ventricular (RV) tear after being stabbed by knife, arriving in emergency unit with massively bleeding chest wound. Complex cardiac trauma involving coronaries and cardiac chambers is a challenge to surgeons if patients miraculously reach the hospital alive. This patient had complete transection of LAD artery with penetration into RV cavity, he was successfully managed by timely and prompt surgical intervention by on call team. This case highlights the importance of team dynamics working in harmony during emergency situations, we stress upon conducting routine drills to train surgical residents, perfusionists and operation theatre staff.


Subject(s)
Heart Injuries , Thoracic Injuries , Wounds, Penetrating , Wounds, Stab , Male , Humans , Wounds, Stab/surgery , Wounds, Stab/complications , Wounds, Penetrating/complications , Thoracic Injuries/complications , Heart Injuries/complications , Heart Injuries/surgery , Coronary Vessels/injuries , Coronary Vessels/surgery
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