Penetrating stab injuries at a single urban unit: are we missing the point?

Abstract

Penetrating trauma--the classical presentation of disorganised crime--can pose a challenge in their management due to their complexity and unpredictability. We examined the experience of one urban unit in the management of penetrating injuries to draw conclusions pertinent to other Irish centres. A retrospective study was performed of all penetrating injuries presenting to the Emergency Department (ED) of Connolly Hospital, Dublin between January 2009 and December 2012. Information was collected from the Hospital Inpatient Enquiry database, theatre logbooks and ED records. One hundred and four patients presented with penetrating injuries in the given period. Four mortalities were recorded. Abdominal injury was recorded in 22% of patients; 26% had multiple injuries not involving the abdomen; 11% had an isolated thoracic injury. Fifty-seven percent required surgery, of which 40% required emergency or early surgical intervention. Laparotomy and laparoscopy were required in 14 and 7%, respectively; 5% required thoracotomy of which two had penetrating cardiac injuries, both of whom survived. Although many patients with penetrating trauma can be safely managed conservatively, our study shows that over half required surgical intervention. These data highlight the need for a trauma team in each Irish centre receiving trauma with a clear need for general surgeons on emergency on-call rotas to be experienced in trauma management. There is an urgent need to centralise the management of trauma to a limited number of designated trauma centres where expertise is available by surgeons with a special interest in trauma management.