gms | German Medical Science

Objectives: Stab injuries increased dramatically in recent years. Patients affected often require immediate surgical care due to traumatic organ injury. Yet, little is known about the initial and interim immunological and haemostasis response to penetrating trauma and whether it may predict clinical outcome measures.

Methods: We retrospectively analysed 258 patients with stab injuries (self-inflicted and assault) in an urban Level-I Trauma Center for injury site and severity, surgical intervention, accompanying peripheral blood cell counts (PBCCs) and haemostasis parameters. We assessed admission and peak C-reactive protein (CRP), haemostasis parameters (International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT)) and PBCCs, as well as changes in respective parameters from admission to peak (delta). Parameters were correlated with length of hospital and intensive care unit (ICU) stay.

Results and conclusion: Of the 258 cases, 210 were assault-related and 48 were self-inflicted. In 2021, we observed significantly more stab injuries compared to previous years. Injuries predominantly affected body cavities (thorax: 48.1%, abdomen: 29.5%). The number of penetrating stabs a patient sustained was positively correlated with length of hospital stay (p=0.3, p<0.001). The number of organ injuries was also positively correlated with length of hospital (p=0.6, p<0.001) and ICU stay (p=0.6, p<0.001). The mean injury severity score was 8.3±7.3, which also positively correlated with length of hospital and ICU stay (p=0.5-0.7, p<0.001).70.5% of patients required immediate surgical intervention. In 258 patients, admission erythrocyte, peak erythrocyte, delta thrombocyte and peak leukocyte counts, peak INR, peak APTT, and delta fibrinogen predicted outcome measures, including length of hospital and ICU stay. Delta leukocyte showed a positive correlation with length of ICU stay (p=0.4, p<0.000). Peak CRP, delta CRP, delta INR and delta aPPT were also positively correlated with hospital and ICU stay length (r=0.5-0.7, p<0.001).

Our data demonstrate the prognostic relevance of PBCCs and haemostasis parameters at and during hospital admission in stab injury patients. The incidence of stab injuries increased, especially during 2021, and immunological parameters may help to identify patients at risk and adjust surgical and intensive care algorithms for the future.