[Gunshot and stab wounds in Germany--epidemiology and outcome: analysis from the TraumaRegister DGU®].
BACKGROUND
The management of gunshot wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. Penetrating injuries occur with an incidence of 5% in Germany. They are caused by gunshots or more commonly by knives or other objects, for example during accidents. Since even the number of patients who are treated at level 1 trauma centres is limited by the low incidence, the objective of this study was to assess the epidemiology and outcome of gunshot and stab wounds in Germany.


METHODS
Since 2009, the trauma registry of the German Trauma Society (TraumaRegister DGU®) has been used to assess not only whether a trauma was penetrating but also whether it was caused by a gunshot or a stabbing. On the basis of this registry, we identified relevant cases and defined the observation period. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2011. We did not specify exclusion criteria in order to obtain as comprehensive a picture as possible of the trauma entities investigated in this study. As a result of the high incidence of gunshot wounds to the head and the implications of this type of injury for the entire group, a subgroup of patients without head injuries was analysed.


RESULTS
From 2009 to 2011, there were 305 patients with gunshot wounds and 871 patients with stab wounds. The high proportion of suicide-related gunshot wounds to the head resulted in a cumulative mortality rate of 39.7%. Stab wounds were associated with a lower mortality rate (6.2%). Every fourth patient with a gunshot or stab wound presented with haemorrhagic shock, which was considerably more frequently seen during the prehospital phase than during the inhospital phase of patient management. Of the patients with gunshot wounds, 26.9% required transfusions. This percentage was three times higher than that for patients with blunt trauma.


CONCLUSIONS
In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicide. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required which can provide the basis for an evaluation of the long-term quality of the management of patients with stab or gunshot wounds.
Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs-, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland, dr.dan.bieler@t-online.de.
D
D
Bieler
A F
AF
Franke
S
S
Hentsch
T
T
Paffrath
A
A
Willms
R
R
Lefering
E W
EW
Kollig
D001803:Blood Transfusion / Q000706:statistics & numerical data; D015984:Causality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006470:Hemorrhage / Q000401:mortality* / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D015996:Survival Rate; D014194:Traumatology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000401:mortality* / Q000628:therapy*; D014951:Wounds, Stab / Q000401:mortality* / Q000628:therapy*