All severely injured patients treated in one of the 12 Swiss trauma centers have been documented in a national registry (STR) since 2015. A Bernese team from the Department of Visceral Surgery and Medicine and the Department of Emergency Medicine at Inselspital, Bern University Hospital, conducted an analysis of the registry for the first time for the period spanning 2017-2019, focusing on gunshot and stab wounds.
Serious injuries caused by firearms and stabbing weapons rare in Switzerland
Violent crimes are very much in the public eye. Dr. med. Christian T. J. Magyar, lead author of the study, explains: “The analysis of the trauma registry shows that only 1.6 percent of all serious injuries listed in the STR are due to firearms and stabbing weapons. This figure is within a similar range in Germany (firearms: 0.5%; stabbing weapons: 1.8%). The death rate for persons hospitalized with serious injuries from firearms or stabbing weapons averages 28.4 percent.”
Lower chance of survival for self-inflicted gunshot wounds
In contrast, the prognosis for certain subgroups is less favorable. For example, only one in two hospitalized individuals survived a serious gunshot wound. If the gunshot wound was self-inflicted, however, mortality for the group studied increased to two-thirds. If the gunshot wound was self-inflicted to the head, mortality was as high as nearly four-fifths of all cases. In comparison, just over four out of five hospitalized serious-injury victims survived gunshot wounds inflicted by third parties.
Mortality from firearms in Switzerland was higher than in Germany during the study period (50% versus 38%). The authors see one explanation in the fact that more persons in Switzerland inflict serious firearm injuries on themselves than in Germany (66% versus 56%). This may be explained by the different firearm regulations and gun culture in Switzerland. The Swiss Army allows conscripts to store service firearms at home, a factor which is difficult to assess in this context.
Torso Injuries: time until emergency admission is decisive
According to the STR, the mortality rate for serious injuries from firearms and stabbing weapons to the trunk of the body (torso) averaged 15 percent. The most common cause of death in this group is a prolonged initiation of diagnostic procedures and treatment of internal bleeding. Therefore, immediate transport to a designated trauma center is the highest priority for these patients.
According to the study results, the duration of time from the arrival of the emergency medical service (EMS) to admission to the emergency center is rather long in international comparison, averaging 57 minutes. It is still comparable to Germany (58-68 minutes), but significantly longer than in the USA (22-44 minutes). However, the duration times from the USA often come from urban centers with short transport distances. Nevertheless, the study authors see potential in this for a possible acceleration in the Swiss rescue system.
Adapt emergency medical services for cases of gunshot and stab wounds
The Bern study, published in the European Journal of Trauma and Emergency Surgery, is the first analysis of gunshot and stab wounds from the Swiss Trauma Registry. It focused on the group of gunshot and stab wound victims who have never been studied nationwide until now and yet require a special strategy in rescue and emergency treatment. A total of 134 individuals met the established criteria (cause of injury, severity of injury). Sixty-four individuals were admitted for severe gunshot wounds, and 70 individuals were admitted for severe stab wounds. The average age was 41 years old, and 83 percent were male.
Outlook, pending questions, further research
This analysis of the trauma registry impressively demonstrates the usefulness of systematic and comprehensive provision of data, a well-neigh impossible feat for a single center to accomplish. For comparison: during the three-year study period, there were only two (0-14) admissions of seriously injured patients with a gunshot or stab wound per center and year. Prof. Dr. med. Beat Schnüriger summarizes: “Severe injuries after gunshot and stab wounding have to be treated very rarely in Swiss hospitals. Nevertheless, we are also repeatedly confronted with this pattern of injury in Switzerland and the treatment results are internationally comparable. We see potential for improvement in an accelerated rescue chain, especially for patients with isolated gunshot or stab wounds to the torso. The centralization of these severely injured patients in the 12 trauma centers can still be advanced. In addition, there is a need for regular and continuous training and education of the teams treating severe penetrating trauma, for example, at the ‘Swiss Trauma & Acute Care Surgery Days’, which takes place annually at Inselspital in Bern.”
European Journal of Trauma and Emergency Surgery
Method of Research
Randomized controlled/clinical trial
Subject of Research
Survival of severe gunshot and stab injuries
Article Publication Date