Evaluation of Stabbing Assault Injuries in A Tertiary Emergency Department: A Retrospective Observational Study 

Evaluation of Stabbing Assault Injuries in A Tertiary Emergency Department: A Retrospective Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Stabbing Assault Injuries in A Tertiary Emergency Department: A Retrospective Observational Study Nil Deniz Kartal Yeter, Mehmet Ali Karaca, Ahmet Sefa Yeter, Elif Öztürk İnce, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4723998/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Sep, 2024 Read the published version in BMC Emergency Medicine → Version 1 posted 10 You are reading this latest preprint version Abstract Background The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED). Methods This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patients’ files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients. Results Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3%(n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement. Conclusion The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-ray and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to need for erythrocyte replacement. Penetrating trauma emergency department trauma scores FAST Stab wound Figures Figure 1 BACKGROUND Trauma is the leading cause of death in healthy young adults aged 5–29 years. The most common factors that cause death are traffic accidents, falls from height, gunshot wounds, and penetrating or stab wounds. Stab trauma by a sharp object (knives, arrows) is classified as a low-velocity wound, and damage is related to depth and angle of attack. The importance of penetrating injuries varies according to the body part, and findings of some penetrating injuries may be initially obscured. Many of these patients could spend the golden hours of trauma in the admission process. Therefore, early evaluation and intervention in patients with penetrating injuries are crucial. This study aimed to evaluate injury patterns of patients admitted to the emergency department with stab wounds, results of the imaging studies, treatment modalities, outcomes, trauma scores, mortality ratios, and complications. METHODS Study Type and Design: This retrospective observational study was conducted as a 10-year survey on 648 patients with stabbing assault admitted to Hacettepe University Emergency Department (ED), Turkey. The hospital is in a city with approximately 5,5 million population and contains all radiological facilities and surgical specialties. All patients with stabbing assault injuries admitted to ED were reviewed. The data were derived from patient files. Patients under 18 or self-injured were excluded from the study. Demographic features of the patients, the mechanism of injury, results and types of diagnostic imaging, modality of treatment, consultations, hospitalization ratio, length of stay, and complication rate and type were evaluated from the patient’s files. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and Probability of survival (Ps) derived from Trauma and Injury Severity Score (TRISS) were calculated for all patients. Data Analysis and Ethical Issue: Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21 for Windows, and p < 0.05 was considered significant. The mean values were used, and an independent t-test was applied in normally distributed variants. Median and interquartile range (IQR) values were used, and the Mann-Whitney U test was applied in non-normally distributed variants. The relations of categorical variants were evaluated with a Chi-Square test. RESULTS Seven hundred sixty eight patients were examined for study. Eighty six patients with self injury and 34 patients under 18 year old were excluded from study. (Figure 1) 564 (87%) of the 648 patients in the study were male. The median age was 28 (IQR:13) years. The most common mechanism was stabbing injuries with a knife (n=348, 54%). When the injuries were ranked according to their location in the body, the most common injuries were detected in the upper extremities (n=301, 46.5%), while the remaining injuries were in the lower extremities (n=185, 28.5%), thorax (n=142, 21,9%), head and neck (n=107, 16,5%) and abdomen (n=106, 16,9%) and genital area (n=3, 0.5%). On admission, hypotension in 57 (8.8%) patients and tachycardia in 168 (26%) patients were detected. (Table 1) Four patients were hypotensive and tachycardic on admission, systolic/diastolic blood pressures could not be measured in 16 patients, and seven patients had cardiac arrest on admission. The median GCS score was 15 (IQR:0). The Glasgow Coma Scale score was lower than 13 in 14 (2.3%) patients. The median RTS was 7.84 (IQR:0). The median ISS was 2(IQR:3). The median Ps was 99.4% (IQR:0.28). The focused assessment with sonography for trauma (FAST) was performed on 88 patients, and fluid was detected in 13. Abdominal computed tomography (CT) was performed in 77 patients. Intra-abdominal solid organ injury in 17 and bowel injury in 10 patients were seen. Abdominal CT was superior to FAST in detecting intra-abdominal injury (p<0.001). Thorax CT was performed in 58 patients, and pneumothorax, hemothorax, and lung or pericardium injuries were detected in 30 of them. Cranial CT was performed in 24 patients, and significant intracranial injuries were detected in 3 patients. Maxillo-facial CT was performed on four patients, and no pathological finding was found except soft tissue injury. Cervical CT was performed in 8 patients, and cervical vertebra injuries were detected in 3. Extremity CT angiography was performed in 7 patients, and vascular injuries were seen in 3. The findings of the diagnostic imaging are summarized in Table 2. Patients were mainly consulted for plastic surgery (32.9%), thoracic-cardiovascular surgery (21.8%), general surgery (18.8%), and orthopedics (6.6%), respectively. One hundred sixty-one patients (24.8%) underwent surgical treatment, local wound care and suturing were performed in 114 (17.6%) by the consulted department, and tube thoracostomy was performed in 29 (4.5%) patients. The consulted departments and the procedures are summarized in Table 3. Among the 648 patients in the study, blood transfusions were performed in 48 (7.4%) of them. In patients who needed erythrocyte replacement, ISS and RTS were significantly higher (p<0.01), and Ps and GCS were found to be significantly lower (p<0.01). 482 (74.4%) patients were treated and discharged from ED. 141 (21.8%) patients were hospitalized and discharged from various in-patient wards, 15 (2.3%) patients were hospitalized in the intensive care unit (ICU), and 10 (1.5%) patients died in ED. The average length of stay in the hospital was 30 hours. The average lengths of stay in the ED, in-patient wards, and the ICU were 7 hours, 133 hours, and 81 hours, respectively. Of the patients that died, four patients had isolated severe thoracic injuries, two patients had thoracic injuries with abdominal injuries, one patient had thoracic injuries with the abdomen and head&neck injuries, one patient had thoracic injuries with lower extremity injuries, one patient had thoracic injuries with upper- extremity injuries, and one patient had lower extremity injuries (femoral artery laceration). Seven patients were brought to the ED in cardiopulmonary arrest. Thoracotomy could not be applied to these seven patients. The patients’ outcomes and trauma scores are summarized in Table 4 . Complications, such as replantation failure, microcirculation disorder, motor dysfunction, wound infection, suture reaction, suture opening, and Richter hernia, developed in 13 (2%) patients . The most frequent complication was peripheral nervous system injury (motor dysfunction) seen in 4 patients. DISCUSSION Trauma is one of the leading causes of death between the ages of 5 and 29 ( 1 ). Penetrating trauma cases is increasing nowadays in parallel with the increase in violence ( 2 ). Injuries due to sharp tools constitute a significant majority of patients in emergency services, which may cause serious health problems in society. The aim of our study is to examine the results of stab injuries, trauma scores, treatment, and outcomes. Penetrating injuries are more common in men and young-middle age groups, up to 90% ( 3 – 6 ). As in other studies in the literature, the majority of the cases (87%) in our study were male patients, and the median age was 28 years for males and 27 years for females. Regarding injury sites, the extremities are most frequently affected in stab injuries, while the thorax, abdomen, and head and neck regions are less frequently affected, respectively ( 5 , 6 ). Similarly, our study found the extremities to be the most common injury site. This was followed by thorax, abdomen, and head and neck injuries. Even though mortality increases with higher scores of ISS, as proposed in 1974, the predictive value of ISS for blood transfusion requirements remained unclear ( 9 ). In many studies, there has been a correlation between ISS and blood transfusion ( 10 – 12 ). As the ISS increases, the need for blood transfusion will also increase ( 13 ). In our study, while ISS values were significantly higher, Ps, RTS, and GCS values ​​were significantly lower in patients undergoing blood transfusion. FAST ultrasonography is a fast, cost-effective imaging method used in trauma patients ( 14 ). The sensitivity and specificity of FAST ultrasonography are quite high ( 15 , 16 ). Similar to the study of Smith et al., our study found that the number of patients who underwent FAST increased significantly in the last 3–4 years ( 16 ). This shows that FAST imaging is performed more frequently by emergency physicians. FAST ultrasonography, performed after a primary survey and combined with physical examination, provides an opportunity for early diagnosis in patients without vital sign changes. A positive finding is useful. However, it is inadequate to exclude all significant injuries, and in a stable patient, more definitive imaging may be appropriate before deciding on intervention. CT is a practical and required method for evaluating stabbing injuries ( 17 ). CT imaging is one of the most critical facilities for managing trauma patients. The short processing time and ability to provide clear and high-quality images are among the most important advantages of CT imaging. In some examinations, high radiation dosage and opaque substances can be considered disadvantages of CT imaging. In our study, soft tissue injury, cranial fracture, intracranial bleeding, and pneumocephalus were the most common findings in brain CT of the patients. The neck region contains vital structures such as major vessels, the spinal canal, and the trachea, so stabbing trauma in the neck requires careful examination. Therefore, CT angiography is often preferred in penetrating neck injuries and is used as an initial diagnostic method for carotid arterial injuries ( 18 ). In the present study, the most common findings in cervical CT were soft tissue injuries and cervical fractures. Thoracic CT provides detailed information about lung, heart, major vascular structures, and diaphragm injuries in penetrating thoracic injuries. Hemothorax, pneumothorax, and rib fractures are the main pathologies detected in many patients who underwent thoracic CT, as in the study ( 19 ). Although FAST provides rapid data on intra-abdominal injuries in stabbing injuries, it is insufficient to detect retroperitoneal, luminal organ, and diaphragm injuries ( 20 ). Therefore, abdominal CT requests should be planned early in cases with stabbing injuries to the abdomen. Using extremity CTs in stabbing traumas provides a great advantage, especially in detecting vascular injuries. Extremity CT is a non-invasive imaging method with high sensitivity and rapid application in detecting vascular injuries ( 21 – 23 ). In our study, vascular injury was observed in 3 of 7 patients with extremity injuries by extremity CT. Treatment of stab wounds may differ depending on the trauma's location, size, and severity. However, most patients are discharged with primary suturing ( 6 , 24 ). In our study, in parallel with the literature, the majority of the patients were treated with simple treatments such as primary suturing and dressing, including suturing by consulted departments in the emergency room. Surgery is frequently applied to patients admitted to the emergency department with stab wounds. Surgery is needed for diagnostic or therapeutic purposes, especially in trunk and neck injuries ( 3 , 6 , 25 ). In our study, 25% of the patients required surgery. The most common surgical procedures were performed by Plastic and Reconstructive Surgery, General Surgery, and Thoracic Surgery, respectively. The most common complications in stab injuries after discharge are wound infections, followed by other potentially fatal complications ( 26 ). In the present study, complications developed in 13 patients. Examination of the outcome of the patients shows that the majority of patients with penetrating trauma are discharged after their treatment in the emergency department as in the other studies( 7 ), and the mortality rate due to penetrating stab injury is less than 10% in most studies ( 3 , 5 ). In our study, while most patients were discharged from the emergency department, the mortality rate associated with penetrating stab injury was 1.5%. Most of the deceased patients were brought to the emergency department as cardiac arrest. LIMITATIONS Since this study was planned as a retrospective study in a single center, the data are limited to patient records. Complications might be overlooked in the period after discharge. The population size could be more significant. CONCLUSION In our study, the majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, although patients are hemodynamically stable, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement. Abbreviations GCS Glasgow Coma Scale RTS Revised Trauma Score ISS Injury Severity Score TRISS Trauma and Injury Severity Score SPSS Statistical Package for Social Sciences FAST Focused Assessment with Sonography for Trauma CT Computed Tomography ED emergency department ICU intensive care unit Ps Probability of survival Declarations Ethics approval and consent to participate: Ethics Committee approval was obtained before the study to derivate the patient files from Ethics Committee of Hacettepe University . (GO 141 49-45). The need for consent to participate was also waived by the ethics committee. Consent for publication: Not Applicable Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due the patients’ files were derived from archives of Hacettepe University but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions: NDKY and MAK have set up the main idea and hypothesis of the study. NDKY and MAK developed the theory and organized the material and method section. EOİ and BE evaluated the data given in the conclusion. NDYK and ASY wrote the discussion part of the article, after MAK reviewed it, made necessary regulations, and approved it. All authors discussed the entire study and approved the final version of the manuscript. Acknowledgements: Not Applicable Authors’ information: Nil Deniz KARTAL YETER*, M.D., Hacettepe University, Vocational School of Health Services, First and Emergency Aid Program, Ankara, TURKEY Mehmet Ali KARACA, Assoc. Prof. Dr., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY Ahmet Sefa YETER, M.D., Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Emergency Service, Ankara, TURKEY Elif ÖZTÜRK İNCE, M.D., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY Bülent ERBİL, Assoc. Prof. Dr., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY References Preventing injuries and violence: an overview: World Health Organization. 2021 [ https://www.who.int/publications/i/item/9789240047136 . Ateşçelik M. Acil Servise Penetran Travma ile Başvuran Hastaların İncelenmesi. Konuralp Med J. 2014;6(1):40–6. Bieler D, Kollig E, Hackenberg L, Rathjen J-H, Lefering R, Franke A. Penetrating injuries in Germany–epidemiology, management and outcome an analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med. 2021;29(1):1–14. 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Computed tomography of the thorax with 3D reconstruction in penetrating chest injury. Med J Malaysia. 2017;72(1):75. Federle M, Goldberg H, Kaiser J, Moss A, Jeffrey R. Evaluation of Abdominal Trauma by Computed Tomography. 50 Landmark Papers every Trauma Surgeon Should Know. CRC; 2019. pp. 85–8. Gakhal MS, Sartip KA. CT angiography signs of lower extremity vascular trauma. Am J Roentgenol. 2009;193(1):W49–57. Wallin D, Yaghoubian A, Rosing D, Walot I, Chauvapun J, de Virgilio C. Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience. Ann Vasc Surg. 2011;25(5):620–3. Kelly SP, Rambau G, Tennent DJ, Osborn PM. The role of CT angiography in evaluating lower extremity trauma: 157 patient case series at a military treatment facility. Mil Med. 2019;184(9–10):e490–3. Schreyer N, Carron P-N, Demartines N. Stab wounds in a Swiss emergency department: a series of 80 consecutive cases. Swiss Med Wkly. 2010(33). Cocco AM, Bhagvan S, Bouffler C, Hsu J. Diagnostic laparoscopy in penetrating abdominal trauma. ANZ J Surg. 2019;89(4):353–6. Jacob AO, Boseto F, Ollapallil J. Epidemic of stab injuries: an Alice Springs dilemma. ANZ J Surg. 2007;77(8):621–5. Tables Table 1. Characteristics of patients n (%) Male sex 564 (87) Injury Site* Head and neck Thorax Abdomen Upper extremity Lower extremity Genital area 107 (16.5) 142 (21.9) 106 (16.9) 301 (46.5) 185 (28.5) 3 (0.5) Hypotension on admission 57 (8.8) Tachycardia on admission 168 (26) FAST performed 88 (13.6) Needed ER 48 (7.4) Outcomes ED-discharge Ward-discharge ICU-discharge Deceased 482 (74.4) 141 (21.8) 15 (2.3) 10 (1.5) *: some patients had concomitant areas of trauma, ER: erythrocyte replacement, ED: emergency department, ICU: intensive care unit. Table 2. Injury area and imaging studies Injury site FAST-CT/CTA numbers FAST findings (n) n=88 CT/CTA findings (n) n=174 Head and neck 0 vs. 32 n/a Cranial fracture and pneumocephaly (1) Cranial fracture and intracranial bleeding (2) Soft tissue injury (8) Cervical vertebra fracture (3) Normal findings (18) Thorax 88 vs 58 Pleural fluid (5) Pericardial fluid (3) Normal (80) Hemopneumothorax (15) Isolated pneumothorax (8) Isolated hemothorax (5) Hemopericardium (1) Hemopneumothorax with hemopericardium (1) Soft tissue injury (13) Normal findings (15) Abdomen 88 vs 77 Fluid (13) Soft tissue injury (8) Liver injury (4) Splenic injury (1) Renal injury (3) Normal (59) Skin and subcutaneous injury (28) Solid organ injury (17) Bowel injury (10) Solid organ and bowel injury (1) Diaphragmatic injury (3) Normal findings (18) Extremities 0 vs 7 n/a Vascular injury (3) Soft tissue injury (2) Normal findings (2) FAST: Focused assessment with sonography for trauma, CT: computerized tomography, CTA: Computerized tomography angiography Table 3. Consulted departments and interventions Department n* (%) Conservative follow-up Surgery Dressing/suturing Plastic & Reconstructive Surgery 213 (32.9) 19 99 95 Thoracic-Cardiovascular Surgery 141 (21.8) 98 46** 7 General Surgery 122 (18.8) 90 31 1 Orthopedic 43 (6.6) 28 7 8 Ear-Nose-Throat 14 (2.2) 8 4 2 Brain Surgery 13 (2.0) 13 0 0 Urology 12 (1.9) 8 3 1 Gynecology 1 (0.2) 1 0 0 * n= 648 , some patients were consulted by more than one department, **: including tube thoracostomy Table 4. Outcome and trauma scores Outcome n % GCS Median (IQR) ISS Median (IQR) RTS Median (IQR) Ps Median (IQR) ED-discharge 482 74.4 15 (0) 1 (3) 7.84 (0) 99.4(0.1) Ward-discharge 141 21.8 15 (0) 9(7) 7.84 (0) 99.1(0.9) ICU-discharge 15 2.3 15 (0) 4(11) 7.84(1.47) 99.3(3.8) Deceased 10 1.5 3(7.25) 22.5(11.5) 0 (5.15) 2.7(49.43) Total 648 100 15(0) 2(3) 7.84(0) 99.4(0.28) GCS: Glasgow Coma Scale; RTS: Revised Trauma Score; ISS: Injury Severity Score; Ps: probability of survival rate IQR: interquartile range. ED: Emergency Department; ICU: Intensive Care Unit. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Sep, 2024 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 31 Jul, 2024 Reviews received at journal 28 Jul, 2024 Reviewers agreed at journal 23 Jul, 2024 Reviews received at journal 22 Jul, 2024 Reviewers agreed at journal 22 Jul, 2024 Reviewers invited by journal 22 Jul, 2024 Editor invited by journal 19 Jul, 2024 Editor assigned by journal 19 Jul, 2024 Submission checks completed at journal 19 Jul, 2024 First submitted to journal 11 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4723998","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":334034755,"identity":"4db9c1ab-84fd-48ba-b5b7-c763508fb157","order_by":0,"name":"Nil Deniz Kartal Yeter","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYDACZuYGCYYDUM4HIGZjJ6iFEaqFjYGBcQaIZiZoDZIWZh6wIQQ0mLMzNt74cMYuX35+87HPNr+2yfMxMzB++JiDW4tlM2Oz5YwbyZYbjrElz87tu23YxszALDlzG24tBocZ26R5PjAbGLDxGDPn9txmBGphY+YlpOXPh3oD+Tb+z8yWPbftidPCcOOwAcMxHmZmhh+3E4nR0mzZc+a4gcGxNGPG3obbyW3MjM34/XL+8MEbP45VG8g3H37M8OPPbdv57c0HP3zEowUVMLaByQZi1YPAH1IUj4JRMApGwUgBAKvPTtH9J8EHAAAAAElFTkSuQmCC","orcid":"","institution":"Hacettepe University","correspondingAuthor":true,"prefix":"","firstName":"Nil","middleName":"Deniz Kartal","lastName":"Yeter","suffix":""},{"id":334034757,"identity":"5022866f-974d-44bc-8157-808f75f7deff","order_by":1,"name":"Mehmet Ali Karaca","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Ali","lastName":"Karaca","suffix":""},{"id":334034760,"identity":"8ec0df37-a60c-42b3-a3cb-bfa2c7a9fb23","order_by":2,"name":"Ahmet Sefa Yeter","email":"","orcid":"","institution":"Ankara Onkoloji Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"Sefa","lastName":"Yeter","suffix":""},{"id":334034762,"identity":"d152bdf5-ffd7-4385-80a0-bb115c7490e0","order_by":3,"name":"Elif Öztürk İnce","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"Öztürk","lastName":"İnce","suffix":""},{"id":334034764,"identity":"923176a3-4610-4d1a-9762-945fffcd721b","order_by":4,"name":"Bülent Erbil","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Bülent","middleName":"","lastName":"Erbil","suffix":""}],"badges":[],"createdAt":"2024-07-11 12:07:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4723998/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4723998/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-024-01077-9","type":"published","date":"2024-09-16T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62797178,"identity":"ba978c0c-9338-4061-873c-c40452431bad","added_by":"auto","created_at":"2024-08-19 15:28:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22596,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Chart of the Study\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4723998/v1/9f0a6c5513b790c49d931205.jpg"},{"id":65109876,"identity":"08176d20-7944-4530-90a0-cb08e2b5b01f","added_by":"auto","created_at":"2024-09-23 17:53:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":587037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4723998/v1/764bfd28-40f2-457a-bf4e-09c638d727cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Stabbing Assault Injuries in A Tertiary Emergency Department: A Retrospective Observational Study ","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eTrauma is the leading cause of death in healthy young adults aged 5\u0026ndash;29 years. The most common factors that cause death are traffic accidents, falls from height, gunshot wounds, and penetrating or stab wounds. Stab trauma by a sharp object (knives, arrows) is classified as a low-velocity wound, and damage is related to depth and angle of attack. The importance of penetrating injuries varies according to the body part, and findings of some penetrating injuries may be initially obscured. Many of these patients could spend the golden hours of trauma in the admission process. Therefore, early evaluation and intervention in patients with penetrating injuries are crucial. This study aimed to evaluate injury patterns of patients admitted to the emergency department with stab wounds, results of the imaging studies, treatment modalities, outcomes, trauma scores, mortality ratios, and complications.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Type and Design:\u003c/h2\u003e \u003cp\u003eThis retrospective observational study was conducted as a 10-year survey on 648 patients with stabbing assault admitted to Hacettepe University Emergency Department (ED), Turkey. The hospital is in a city with approximately 5,5\u0026nbsp;million population and contains all radiological facilities and surgical specialties.\u003c/p\u003e \u003cp\u003eAll patients with stabbing assault injuries admitted to ED were reviewed. The data were derived from patient files. Patients under 18 or self-injured were excluded from the study. Demographic features of the patients, the mechanism of injury, results and types of diagnostic imaging, modality of treatment, consultations, hospitalization ratio, length of stay, and complication rate and type were evaluated from the patient\u0026rsquo;s files. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and Probability of survival (Ps) derived from Trauma and Injury Severity Score (TRISS) were calculated for all patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis and Ethical Issue:\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21 for Windows, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. The mean values were used, and an independent t-test was applied in normally distributed variants. Median and interquartile range (IQR) values were used, and the Mann-Whitney U test was applied in non-normally distributed variants. The relations of categorical variants were evaluated with a Chi-Square test.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSeven hundred sixty eight patients were examined for study. Eighty six patients with self injury and 34 patients under 18 year old were excluded from study. (Figure 1) 564 (87%) of the 648 patients in the study were male. The median age was 28 (IQR:13) years. The most common mechanism was stabbing injuries with a knife (n=348, 54%). When the injuries were ranked according to their location in the body, the most common injuries were detected in the upper extremities (n=301, 46.5%), while the remaining injuries were in the lower extremities (n=185, 28.5%), thorax (n=142, 21,9%), head and neck (n=107, 16,5%) and abdomen (n=106, 16,9%) and genital area (n=3, 0.5%). On admission, hypotension in 57 (8.8%) patients and tachycardia in 168 (26%) patients were detected. (Table 1) Four patients were hypotensive and tachycardic on admission, systolic/diastolic blood pressures could not be measured in 16 patients, and seven patients had cardiac arrest on admission. The median GCS score was 15 (IQR:0). The Glasgow Coma Scale score was lower than 13 in 14 (2.3%) patients. The median RTS was 7.84 (IQR:0). The median ISS was 2(IQR:3). The median Ps was 99.4% (IQR:0.28).\u003c/p\u003e\n\u003cp\u003eThe focused assessment with sonography for trauma (FAST) was performed on 88 patients, and fluid was detected in 13. Abdominal computed tomography (CT) was performed in 77 patients. Intra-abdominal solid organ injury in 17 and bowel injury in 10 patients were seen. Abdominal CT was superior to FAST in detecting intra-abdominal injury (p\u0026lt;0.001). Thorax CT was performed in 58 patients, and pneumothorax, hemothorax, and lung or pericardium injuries were detected in 30 of them. Cranial CT was performed in 24 patients, and significant intracranial injuries were detected in 3 patients. Maxillo-facial CT was performed on four patients, and no pathological finding was found except soft tissue injury. Cervical CT was performed in 8 patients, and cervical vertebra injuries were detected in 3. Extremity CT angiography was performed in 7\u0026nbsp;patients, and vascular injuries were seen in 3. The findings of the diagnostic imaging are summarized in Table 2.\u003c/p\u003e\n\u003cp\u003ePatients were mainly consulted for plastic surgery (32.9%), thoracic-cardiovascular surgery (21.8%), general surgery (18.8%), and orthopedics (6.6%), respectively. One hundred sixty-one patients (24.8%) underwent surgical treatment, local wound care and suturing were performed in 114 (17.6%) by the consulted department, and tube thoracostomy was performed in 29 (4.5%) patients.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe consulted departments and the procedures are summarized in Table 3.\u003c/p\u003e\n\u003cp\u003eAmong the 648 patients in the study, blood transfusions were performed in 48 (7.4%) of them. In patients who needed erythrocyte replacement, ISS and RTS were significantly higher (p\u0026lt;0.01), and Ps and GCS were found to be significantly lower (p\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003e482 (74.4%) patients were treated and discharged from ED. 141 (21.8%) patients were hospitalized and discharged from various in-patient wards, 15 (2.3%) patients were hospitalized in the intensive care unit (ICU), and 10 (1.5%) patients died in ED. The average length of stay in the hospital was 30 hours. The average lengths of stay in the ED, in-patient wards, and the ICU were 7 hours, 133 hours, and 81 hours, respectively.\u003c/p\u003e\n\u003cp\u003eOf the patients that died, four patients had isolated severe thoracic injuries, two patients had thoracic injuries with abdominal injuries, one patient had thoracic injuries with the abdomen and head\u0026amp;neck injuries, one patient had thoracic injuries with lower extremity injuries, one patient had thoracic injuries with upper- extremity injuries, and one patient had lower extremity injuries (femoral artery laceration). Seven patients were brought to the ED in cardiopulmonary arrest. Thoracotomy could not be applied to these seven patients. The patients\u0026rsquo; outcomes and trauma scores are summarized in Table 4\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComplications, such as replantation failure, microcirculation disorder, motor dysfunction, wound infection, suture reaction, suture opening, and Richter hernia, developed in 13 (2%) patients\u003cstrong\u003e.\u003c/strong\u003e The most frequent complication was\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eperipheral nervous system injury (motor dysfunction) seen in 4 patients.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTrauma is one of the leading causes of death between the ages of 5 and 29 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Penetrating trauma cases is increasing nowadays in parallel with the increase in violence (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Injuries due to sharp tools constitute a significant majority of patients in emergency services, which may cause serious health problems in society. The aim of our study is to examine the results of stab injuries, trauma scores, treatment, and outcomes.\u003c/p\u003e \u003cp\u003ePenetrating injuries are more common in men and young-middle age groups, up to 90% (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). As in other studies in the literature, the majority of the cases (87%) in our study were male patients, and the median age was 28 years for males and 27 years for females. Regarding injury sites, the extremities are most frequently affected in stab injuries, while the thorax, abdomen, and head and neck regions are less frequently affected, respectively (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Similarly, our study found the extremities to be the most common injury site. This was followed by thorax, abdomen, and head and neck injuries.\u003c/p\u003e \u003cp\u003eEven though mortality increases with higher scores of ISS, as proposed in 1974, the predictive value of ISS for blood transfusion requirements remained unclear (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In many studies, there has been a correlation between ISS and blood transfusion (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). As the ISS increases, the need for blood transfusion will also increase (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In our study, while ISS values were significantly higher, Ps, RTS, and GCS values ​​were significantly lower in patients undergoing blood transfusion.\u003c/p\u003e \u003cp\u003eFAST ultrasonography is a fast, cost-effective imaging method used in trauma patients (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The sensitivity and specificity of FAST ultrasonography are quite high (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Similar to the study of Smith et al., our study found that the number of patients who underwent FAST increased significantly in the last 3\u0026ndash;4 years (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This shows that FAST imaging is performed more frequently by emergency physicians. FAST ultrasonography, performed after a primary survey and combined with physical examination, provides an opportunity for early diagnosis in patients without vital sign changes. A positive finding is useful. However, it is inadequate to exclude all significant injuries, and in a stable patient, more definitive imaging may be appropriate before deciding on intervention.\u003c/p\u003e \u003cp\u003eCT is a practical and required method for evaluating stabbing injuries (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). CT imaging is one of the most critical facilities for managing trauma patients. The short processing time and ability to provide clear and high-quality images are among the most important advantages of CT imaging. In some examinations, high radiation dosage and opaque substances can be considered disadvantages of CT imaging. In our study, soft tissue injury, cranial fracture, intracranial bleeding, and pneumocephalus were the most common findings in brain CT of the patients. The neck region contains vital structures such as major vessels, the spinal canal, and the trachea, so stabbing trauma in the neck requires careful examination. Therefore, CT angiography is often preferred in penetrating neck injuries and is used as an initial diagnostic method for carotid arterial injuries (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In the present study, the most common findings in cervical CT were soft tissue injuries and cervical fractures. Thoracic CT provides detailed information about lung, heart, major vascular structures, and diaphragm injuries in penetrating thoracic injuries. Hemothorax, pneumothorax, and rib fractures are the main pathologies detected in many patients who underwent thoracic CT, as in the study (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Although FAST provides rapid data on intra-abdominal injuries in stabbing injuries, it is insufficient to detect retroperitoneal, luminal organ, and diaphragm injuries (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Therefore, abdominal CT requests should be planned early in cases with stabbing injuries to the abdomen. Using extremity CTs in stabbing traumas provides a great advantage, especially in detecting vascular injuries. Extremity CT is a non-invasive imaging method with high sensitivity and rapid application in detecting vascular injuries (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In our study, vascular injury was observed in 3 of 7 patients with extremity injuries by extremity CT.\u003c/p\u003e \u003cp\u003eTreatment of stab wounds may differ depending on the trauma's location, size, and severity. However, most patients are discharged with primary suturing (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our study, in parallel with the literature, the majority of the patients were treated with simple treatments such as primary suturing and dressing, including suturing by consulted departments in the emergency room.\u003c/p\u003e \u003cp\u003eSurgery is frequently applied to patients admitted to the emergency department with stab wounds. Surgery is needed for diagnostic or therapeutic purposes, especially in trunk and neck injuries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In our study, 25% of the patients required surgery. The most common surgical procedures were performed by Plastic and Reconstructive Surgery, General Surgery, and Thoracic Surgery, respectively.\u003c/p\u003e \u003cp\u003eThe most common complications in stab injuries after discharge are wound infections, followed by other potentially fatal complications (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In the present study, complications developed in 13 patients. Examination of the outcome of the patients shows that the majority of patients with penetrating trauma are discharged after their treatment in the emergency department as in the other studies(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and the mortality rate due to penetrating stab injury is less than 10% in most studies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In our study, while most patients were discharged from the emergency department, the mortality rate associated with penetrating stab injury was 1.5%. Most of the deceased patients were brought to the emergency department as cardiac arrest.\u003c/p\u003e\n\u003ch3\u003eLIMITATIONS\u003c/h3\u003e\n\u003cp\u003eSince this study was planned as a retrospective study in a single center, the data are limited to patient records. Complications might be overlooked in the period after discharge. The population size could be more significant.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn our study, the majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, although patients are hemodynamically stable, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRevised Trauma Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInjury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTRISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrauma and Injury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocused Assessment with Sonography for Trauma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eemergency department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProbability of survival\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthics Committee approval was obtained before the study to derivate the patient files from Ethics Committee of Hacettepe University . (GO 141 49-45). The need for consent to participate was also waived by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analysed during the current study are not publicly available due the patients\u0026rsquo; files were derived from archives of Hacettepe University but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eNDKY and MAK have set up the main idea and hypothesis of the study. NDKY and MAK \u0026nbsp;developed the theory and organized the material and method section. EOİ and BE evaluated the data given in the conclusion. NDYK and ASY wrote the discussion part of the article, after MAK reviewed it, made necessary regulations, and approved it. All authors discussed the entire study and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil Deniz KARTAL YETER*, M.D., Hacettepe University, Vocational School of Health Services, First and Emergency Aid Program, Ankara, TURKEY\u003c/p\u003e\n\u003cp\u003eMehmet Ali KARACA, Assoc. Prof. Dr., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAhmet Sefa YETER, M.D., Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Emergency Service, Ankara, TURKEY\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eElif \u0026Ouml;ZT\u0026Uuml;RK İNCE, M.D., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY\u003c/p\u003e\n\u003cp\u003eB\u0026uuml;lent ERBİL, Assoc. Prof. Dr., Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, Ankara, TURKEY\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePreventing injuries and violence: an overview: World Health Organization. 2021 [ \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240047136\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240047136\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAteş\u0026ccedil;elik M. Acil Servise Penetran Travma ile Başvuran Hastaların İncelenmesi. Konuralp Med J. 2014;6(1):40\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBieler D, Kollig E, Hackenberg L, Rathjen J-H, Lefering R, Franke A. Penetrating injuries in Germany\u0026ndash;epidemiology, management and outcome an analysis based on the TraumaRegister DGU\u0026reg;. Scand J Trauma Resusc Emerg Med. 2021;29(1):1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAjayi B, Guthrie H, Trompeter A, Tennent D, Lui DF. The rising burden of penetrating knife injuries. Inj Prev. 2021;27(5):467\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePallett J, Sutherland E, Glucksman E, Tunnicliff M, Keep J. A cross-sectional study of knife injuries at a London major trauma centre. Annals Royal Coll Surg Engl. 2014;96(1):23\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKharytaniuk N, Bass G, Salih A, Twyford M, O\u0026rsquo;Conor E, Collins N, et al. Penetrating stab injuries at a single urban unit: are we missing the point? Ir J Med Sci (1971-). 2015;184(2):449\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrhon R, EREN Ş, KARADAYI Ş, Korkmaz İ, Coşkun A, Eren M et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. ULUSAL TRAVMA VE ACIL CERRAHI DERGISI-TURKISH JOURNAL OF TRAUMA \u0026amp; EMERGENCY SURGERY. 2014;20(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeshmukh VU, Ketkar MN, Bharucha EK. Analysis of trauma outcome using the TRISS method at a tertiary care centre in Pune. Indian J Surg. 2012;74(6):440\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRotondo M, Fildes J, Brasel K, Kortbeek J, Al Turki S, Atkinson J. ATLS Advanced Trauma Life Support for Doctors\u0026mdash;Student Course Manual. Chicago, IL: American College of Surgeons; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrstić S, Alempijević T, Popović N, Jovanović D, Mihailović V, Šijački A. Nadoknada krvi kod teško povređenih bolesnika. Acta Chir Iugosl. 2010;57(1):107\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEksert S, \u0026Uuml;nl\u0026uuml; A, Aydın FN, Kaya M, Aşık MB, Kantemir A, et al. Analysis of anatomical localization and severity of injury in patients with blood transfusion in urban terrain hospital. Ulus Travma Acil Cerrahi Derg. 2020;26(6):937\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotwal RS, Scott LL, Janak JC, Tarpey BW, Howard JT, Mazuchowski EL, et al. The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq. J trauma acute care Surg. 2018;85(1S):S112\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheng AY, Dalziel P, Liteplo AS, Fagenholz P, Noble VE. Focused assessment with sonography in trauma and abdominal computed tomography utilization in adult trauma patients: trends over the last decade. Emergency medicine international. 2013;2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaurer M, Winkler A, Wichlas F, Powerski M, Elgeti F, Huppertz A, et al. Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography. Rofo: Fortschr auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2011;184(1):53\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith ZA, Wood D. Emergency focussed assessment with sonography in trauma (FAST) and haemodynamic stability. Emerg Med J. 2014;31(4):273\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubcommittee A, Group IAW. Advanced trauma life support (ATLS\u0026reg;): the ninth edition. J trauma acute care Surg. 2013;74(5):1363\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang G, Li C, Piao J, Xu B, Yu J. Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma. Int J Med Sci. 2021;18(4):944.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArvind M, Yahya Z, Ibrahim R, Hussein H. Computed tomography of the thorax with 3D reconstruction in penetrating chest injury. Med J Malaysia. 2017;72(1):75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederle M, Goldberg H, Kaiser J, Moss A, Jeffrey R. Evaluation of Abdominal Trauma by Computed Tomography. 50 Landmark Papers every Trauma Surgeon Should Know. CRC; 2019. pp. 85\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGakhal MS, Sartip KA. CT angiography signs of lower extremity vascular trauma. Am J Roentgenol. 2009;193(1):W49\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallin D, Yaghoubian A, Rosing D, Walot I, Chauvapun J, de Virgilio C. Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience. Ann Vasc Surg. 2011;25(5):620\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly SP, Rambau G, Tennent DJ, Osborn PM. The role of CT angiography in evaluating lower extremity trauma: 157 patient case series at a military treatment facility. Mil Med. 2019;184(9\u0026ndash;10):e490\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchreyer N, Carron P-N, Demartines N. Stab wounds in a Swiss emergency department: a series of 80 consecutive cases. Swiss Med Wkly. 2010(33).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCocco AM, Bhagvan S, Bouffler C, Hsu J. Diagnostic laparoscopy in penetrating abdominal trauma. ANZ J Surg. 2019;89(4):353\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacob AO, Boseto F, Ollapallil J. Epidemic of stab injuries: an Alice Springs dilemma. ANZ J Surg. 2007;77(8):621\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Characteristics of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eMale sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e564 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eInjury Site*\u003c/p\u003e\n \u003cp\u003eHead and neck\u003c/p\u003e\n \u003cp\u003eThorax\u003c/p\u003e\n \u003cp\u003eAbdomen\u003c/p\u003e\n \u003cp\u003eUpper extremity\u003c/p\u003e\n \u003cp\u003eLower extremity\u003c/p\u003e\n \u003cp\u003eGenital area\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107 (16.5)\u003c/p\u003e\n \u003cp\u003e142 (21.9)\u003c/p\u003e\n \u003cp\u003e106 (16.9)\u003c/p\u003e\n \u003cp\u003e301 (46.5)\u003c/p\u003e\n \u003cp\u003e185 (28.5)\u003c/p\u003e\n \u003cp\u003e3 (0.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eHypotension on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e57 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eTachycardia on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e168 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eFAST performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e88 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNeeded ER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e48 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003cp\u003eED-discharge\u003c/p\u003e\n \u003cp\u003eWard-discharge\u003c/p\u003e\n \u003cp\u003eICU-discharge\u003c/p\u003e\n \u003cp\u003eDeceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e482 (74.4)\u003c/p\u003e\n \u003cp\u003e141 (21.8)\u003c/p\u003e\n \u003cp\u003e15 (2.3)\u003c/p\u003e\n \u003cp\u003e10 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*: some patients had concomitant areas of trauma, ER: erythrocyte replacement, ED: emergency department, ICU: intensive care unit.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eInjury area and imaging studies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.984227129337539%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjury site\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.987381703470032%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFAST-CT/CTA numbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.817034700315457%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFAST findings (n) n=88\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.21135646687697%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT/CTA findings (n)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.984227129337539%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHead and neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.987381703470032%\" valign=\"top\"\u003e\n \u003cp\u003e0 vs. 32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.817034700315457%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.21135646687697%\" valign=\"top\"\u003e\n \u003cp\u003eCranial fracture and pneumocephaly (1)\u003c/p\u003e\n \u003cp\u003eCranial fracture and intracranial bleeding (2)\u003c/p\u003e\n \u003cp\u003eSoft tissue injury (8)\u003c/p\u003e\n \u003cp\u003eCervical vertebra fracture (3)\u003c/p\u003e\n \u003cp\u003eNormal findings (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.984227129337539%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThorax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.987381703470032%\" valign=\"top\"\u003e\n \u003cp\u003e88 vs 58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.817034700315457%\" valign=\"top\"\u003e\n \u003cp\u003ePleural fluid (5)\u003c/p\u003e\n \u003cp\u003ePericardial fluid (3)\u003c/p\u003e\n \u003cp\u003eNormal (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.21135646687697%\" valign=\"top\"\u003e\n \u003cp\u003eHemopneumothorax (15)\u003c/p\u003e\n \u003cp\u003eIsolated pneumothorax (8)\u003c/p\u003e\n \u003cp\u003eIsolated hemothorax (5)\u003c/p\u003e\n \u003cp\u003eHemopericardium (1)\u003c/p\u003e\n \u003cp\u003eHemopneumothorax with hemopericardium (1)\u003c/p\u003e\n \u003cp\u003eSoft tissue injury (13)\u003c/p\u003e\n \u003cp\u003eNormal findings (15)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.984227129337539%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.987381703470032%\" valign=\"top\"\u003e\n \u003cp\u003e88 vs 77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.817034700315457%\" valign=\"top\"\u003e\n \u003cp\u003eFluid (13)\u003c/p\u003e\n \u003cp\u003eSoft tissue injury (8)\u003c/p\u003e\n \u003cp\u003eLiver injury (4)\u003c/p\u003e\n \u003cp\u003eSplenic injury (1)\u003c/p\u003e\n \u003cp\u003eRenal injury (3)\u003c/p\u003e\n \u003cp\u003eNormal (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.21135646687697%\" valign=\"top\"\u003e\n \u003cp\u003eSkin and subcutaneous injury (28)\u003c/p\u003e\n \u003cp\u003eSolid organ injury (17)\u003c/p\u003e\n \u003cp\u003eBowel injury (10)\u003c/p\u003e\n \u003cp\u003eSolid organ and bowel injury (1)\u003c/p\u003e\n \u003cp\u003eDiaphragmatic injury (3)\u003c/p\u003e\n \u003cp\u003eNormal findings (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.984227129337539%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtremities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.987381703470032%\" valign=\"top\"\u003e\n \u003cp\u003e0 vs 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.817034700315457%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.21135646687697%\" valign=\"top\"\u003e\n \u003cp\u003eVascular injury (3)\u003c/p\u003e\n \u003cp\u003eSoft tissue injury (2)\u003c/p\u003e\n \u003cp\u003eNormal findings (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFAST: Focused assessment with sonography for trauma, CT: computerized tomography, CTA: Computerized tomography angiography\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Consulted departments and interventions \u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n* (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConservative follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDressing/suturing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlastic \u0026amp; Reconstructive Surgery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e213\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThoracic-Cardiovascular Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003cp\u003e(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e46**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003cp\u003e(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrthopedic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003cp\u003e(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEar-Nose-Throat\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrain Surgery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.98563734290844%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGynecology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.671454219030522%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8491921005386%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.644524236983843%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003en= 648\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003esome patients were consulted by more than one department, **: including tube thoracostomy\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Outcome and trauma scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(IQR)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eISS Median\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRTS Median\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePs Median\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eED-discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e15 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e7.84 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e99.4(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWard-discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e15 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e9(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e7.84 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e99.1(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU-discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e15 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e4(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e7.84(1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e99.3(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e3(7.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e22.5(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e0 (5.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e2.7(49.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" valign=\"top\"\u003e\n \u003cp\u003e648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.051529790660226%\" valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e15(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.136876006441224%\" valign=\"top\"\u003e\n \u003cp\u003e2(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\" valign=\"top\"\u003e\n \u003cp\u003e7.84(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.611916264090176%\" valign=\"top\"\u003e\n \u003cp\u003e99.4(0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGCS: Glasgow Coma Scale; RTS: Revised Trauma Score; ISS: Injury Severity Score; Ps: probability of survival rate IQR: interquartile range. ED: Emergency Department; ICU: Intensive Care Unit.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Penetrating trauma, emergency department, trauma scores, FAST, Stab wound","lastPublishedDoi":"10.21203/rs.3.rs-4723998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4723998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patients\u0026rsquo; files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n\u0026thinsp;=\u0026thinsp;482) were treated in ED and 21.8% (n\u0026thinsp;=\u0026thinsp;141) of patients were hospitalized in wards, 2.3%(n\u0026thinsp;=\u0026thinsp;15) in intensive care unit and 1.5% (n\u0026thinsp;=\u0026thinsp;10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-ray and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to need for erythrocyte replacement.\u003c/p\u003e","manuscriptTitle":"Evaluation of Stabbing Assault Injuries in A Tertiary Emergency Department: A Retrospective Observational Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-19 15:28:40","doi":"10.21203/rs.3.rs-4723998/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-31T05:25:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-28T14:44:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335169425937064780494051577678017418526","date":"2024-07-23T13:25:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-22T17:22:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133788569170931067984520297049031573754","date":"2024-07-22T16:49:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-22T16:47:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-19T09:10:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-19T09:09:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-19T09:08:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2024-07-11T12:06:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e07cc021-daf3-45ea-a382-4792d9a5daa1","owner":[],"postedDate":"August 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T17:52:57+00:00","versionOfRecord":{"articleIdentity":"rs-4723998","link":"https://doi.org/10.1186/s12873-024-01077-9","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2024-09-16 15:57:30","publishedOnDateReadable":"September 16th, 2024"},"versionCreatedAt":"2024-08-19 15:28:40","video":"","vorDoi":"10.1186/s12873-024-01077-9","vorDoiUrl":"https://doi.org/10.1186/s12873-024-01077-9","workflowStages":[]},"version":"v1","identity":"rs-4723998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4723998","identity":"rs-4723998","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}