title: Low incidence of penetrating trauma in a high-volume tertiary center: 10-year mortality review.
abstract: BACKGROUND
  Trauma morbidity and mortality outcome is better in high-volume trauma centers. However, there are few publications investigating the experience of high-volume centers with high non-trauma emergency load but seeing a relatively low incidence of trauma. The objective of this study is to review the presentation and outcomes for the low volume of patients presenting with penetrating injuries in a high-volume hospital.
  
  
  METHODS
  Data were extracted from the Singapore General Hospital database between 1998 and 2007. There were 1,233 patients who sustained penetrating injuries and were brought to the hospital during the 10-year period. Of these, only 78 patients had injury severity score (ISS) values of 16 or more. In the same period, there were 1,270 patients with ISS > 15 who were admitted with blunt injury. SPSS 10.1 was used to conduct univariate and multivariate analyses to elucidate risk factors for mortality.
  
  
  RESULTS
  Age, ISS, and trauma injury severity score (TRISS) were significant predictors of mortality. Gender and type of injury were not predictive of mortality. Mortality outcomes were independently predicted by age, TRISS, and ISS. The most common site of injury was the chest, followed closely by the head and neck. The abdomen/pelvis was the third most common site of injury. There was no significant difference in anatomical site injury pattern between the survivors and non-survivors. For both groups, chest injuries and head and neck injuries dominated, with maximal abdominal/pelvic injuries a distant third.
  
  
  CONCLUSIONS
  With a trauma system in place, high-volume centers with a low volume of penetrating injury patients can still manage uncommon injuries without jeopardizing patient care.
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore. wong.th@doctors.org.uk.
authors.forename: T H
authors.initials: TH
authors.lastname: Wong
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore.
authors.forename: G
authors.initials: G
authors.lastname: Tan
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore.|Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: P
authors.initials: P
authors.lastname: Madhukumar
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Ng
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore.|Trauma Service, Singapore General Hospital, Singapore, Singapore.
authors.forename: M P
authors.initials: MP
authors.lastname: Koh
authors.affiliation: General Surgery, Singapore General Hospital, Outram Road, Block 6 level 7, Singapore, 169608, Singapore.
authors.forename: A Y F
authors.initials: AY
authors.lastname: Chung
keywords: Emergency surgery; Penetrating injury; Trauma activation; Trauma care regionalisation; Trauma systems
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