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Epidemic of stab injuries: An Alice Springs dilemma
Abstract
This study is unique in that it strives to unfold, perhaps for the first time, the problem of stab injuries and resultant significant mortality and morbidity within the Aboriginal population of Central Australia. Demographic features presented in the study are quite different from other published Australasian and overseas experiences. There were 1550 stab injury admissions to Alice Springs Hospital during a 7-year period (July 1998 to June 2005). Thirty-two patients were dead before arrival, and there were only three deaths in the hospital during the period of study. The most unique demographic feature was that 99.99% were Aborigines, 53% were women and the most common location of injury was in town camps and homes. The mean age of this population was 31 years, and the average length of stay in hospital was 3 days. The most common site of the stab injuries was the thigh with a total of 605 (38%). Stab injuries to the abdomen were significantly low with 68 (<1%). Twenty-one per cent (332) presented 24 h to 10 days after stabbing. Another 21% (335) absconded before the completion of treatment. Of the victims, 31% (481) were under the influence of alcohol. Twenty per cent (311) of the patients presented with repeat stabbings during the study period. Traditional punishment is still practised in Central Australia and thus explains the high number of thigh injuries. A particular pattern of traditional stab injuries was also noted; medial thigh to kill, posterior thigh to permanently disable and lateral thigh to punish. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were only five firearm traumas during this period, two were self-inflicted and three were accidental.
... Indigenous Australians experience relatively high rates of injury and death from accidents and violence compared to their non-Indigenous counterparts [1]. Factors such as excessive alcohol consumption, low socioeconomic status, and overcrowding [1][2][3] contribute to this disparity. However, it is also recognized that a cultural dimension, specifically, the application of customary law, continues to account for some of the injuries in this population [4,5]. ...
... An analysis of stab injury cases presenting to the Alice Springs Hospital in Central Australia demonstrated that the predominant anatomical site of injury was the thigh, a finding that was attributed to the practices of traditional punishment [3]. It was suggested that stab injuries to the posterior thigh are intended to punish and permanently disable the victim, whereas injuries to the lateral and anterior thigh are executed to punish for lesser crimes [3]. ...
... An analysis of stab injury cases presenting to the Alice Springs Hospital in Central Australia demonstrated that the predominant anatomical site of injury was the thigh, a finding that was attributed to the practices of traditional punishment [3]. It was suggested that stab injuries to the posterior thigh are intended to punish and permanently disable the victim, whereas injuries to the lateral and anterior thigh are executed to punish for lesser crimes [3]. In the reported case the presence of a single stab wound in the posterior thigh with no defense wounds or other injuries to suggest an assault was in keeping with traditional punishment, although apparently not in the context of a customary law setting. ...
... Studies regarding assault induced stab injuries show a steady increase of incidence in England (2), stagnation in Sweden (3), but a decline in Australia (4)(5). Different sorts of preventive measures taken by local authorities in various countries, may explain the wide variation in incidence. ...
... Despite an increasing rate of interpersonal violence in the city of Antwerp (6) a significant decline of stab injuries was noted in our study between 2002 and 2004. The incidence then doubled in the subsequent two- year period (see 5). This strange fact remains difficult to explain and may reflect the complexity of the true incidence of stabbing assaults and their multiple determinants, not the least the choices made by patients' families or by ambulance officials in directing the victims to one or another hospital. ...
... Besides gender, age and ethnicity, alcohol is also strongly associated with penetrating wounds and especially stab wounds (7). JACOB et al. (5) reported a substantial decrease of stab wounds in Alice Springs (Australia), after restrictive measures were undertaken regarding alcohol consumption in the aboriginal community. Preventive measures have likewise been promised in Belgium and might include higher taxation on alcohol as well as a reduction of alcohol commercial publicity (9). ...
To investigate and analyse epidemiology, demographics and patterns of presentation of assault induced stab injuries in a main Belgian trauma centre. To evaluate surgical management, complications and postoperative follow-up of the stab wound victims.
One hundred and seventy assaulted patients, hospitalised because of stab injuries from January 2000 to June 2007 are studied retrospectively.
Ninety-five percent of the assaults occurred on men and the mean age of the patients was 31.1 +/- 9.7 years. Ethnic minorities represent 77% of the patients hospitalised for assaults and 26.5% of all patients proved to be under toxic influence, predominantly from alcohol (21.8%). A decline of admissions of patients with stab injuries during the period 2002-2004 is recorded. However, the incidence doubled in the next two-year period. A weekend peak and circadian rhythm is apparent with more than 20% of the patients admitted between 4 and 6 am. The trunk is most frequently stabbed (54.5%) resulting in a laparotomy rate of 51%. One third of the patients who underwent thoraco-abdominal surgery revealed diaphragmatic injuries. Seventy-five percent of the patients left the hospital in a good condition while 2.4% had neuromuscular lesions. Two patients had serious vascular complications during follow-up. During the study period, no mortality was recorded.
Stab wounds were recorded mainly in young and middle-aged men from ethnic minorities, whereas almost 27% were under the influence of drugs. A conservative approach was generally used resulting in a low laparotomy and thoracotomy rate without affecting mortality. Neuromuscular lesions are important long-term complications of stab injuries.
... Unlike in other studies where the percentage of female victims ranged from 30 to 35% [5,[10][11][12], it was slightly higher in this study, namely 39%. In general, the male to female ratio in the published studies varies from 2 to 5, with the exception of the study by Belghith et al. involving Aboriginal population in Central Australia where female victims accounted for 53% of all the victims [13][14][15]. Such high number of female victims in Aborigines population could be explained by the use of traditional punishment, which is still practiced in Central Australia [15]. ...
... In general, the male to female ratio in the published studies varies from 2 to 5, with the exception of the study by Belghith et al. involving Aboriginal population in Central Australia where female victims accounted for 53% of all the victims [13][14][15]. Such high number of female victims in Aborigines population could be explained by the use of traditional punishment, which is still practiced in Central Australia [15]. ...
This paper presents a retrospective review of patterns found in cases of homicides by sharp force over a 13-year period at the Department of Forensic Pathology of the Ostrava University Hospital, Czech Republic. The review summarizes all frequently discussed aspects of such cases including the number and localization of injuries, the presence of defensive wounds, the type of the offending weapon, the cause of death, the place of death, victims' and perpetrators' profiles, their relationship, or toxicological findings. Furthermore, special attention was paid to the evaluation of any accompanying blunt force trauma that may be indicative of an escalation of the assault. The set of data was statistically analyzed. Even though most of the results of this review are consistent with available published studies, noteworthy differences have emerged in some aspects such as the sex and age of the victims, the relationship between the number of injuries suffered and the victims' sex, or the severity of alcohol intoxication in victims.
... Vascular injuries represent less than 3% of all traumatic findings and have a potential to cause morbidity and mortality if they are not timely recognized and treated [1][2][3][4]. The majority of vascular injuries occur in the extremities and may result from penetrating trauma, blunt trauma, or both. ...
... Among them, gunshot injury is the leading cause, followed by stab wounds and blunt trauma [1]. Mortality is mainly related to hypovolemia after a major vessel is injured, while morbidity may result secondary to compartment syndrome, arteriovenous fistula, limb loss or wound infections [1][2][3][4]. ...
Background:
Traumatic vascular injury of the limbs has the potential to cause substantial patient morbidity and mortality, and therefore, early recognition and treatment are crucial to improve outcomes. While patients with hard signs of arterial injury mandate for an immediate surgical intervention, patients presenting with soft signs of arterial injury need further diagnostic evaluation.
Case presentation:
A 24-year-old male was admitted to the emergency department after suffering a stab wound in the anterolateral aspect of his left upper thigh. Entry wound measures approximately 3 cm × 0.7 cm; no exit wound was observed. On examination of the injured limb, the thigh was swollen and painful. Skin color was mildly pale and skin temperature was slightly diminished in his leg; leg numbness was also pointed out by the patient. Common femoral artery pulse was normal, while distal pulses were diminished. Point-of-care Doppler ultrasound (DUS) showed a subfascial hematoma in the thigh, which filled on color Doppler, corresponding to a pseudoaneurysm. On spectral Doppler, signs of distal low blood supply were noted. The patient was immediately transferred to the operating room where a 1-cm laceration was found in the anterior aspect of the superficial femoral artery. The involved artery was successfully repaired and distal flow was reestablished, as assessed by clinical examination, pulse palpation and DUS.
Conclusions:
Based on its several advantages, DUS should be considered as the first-line diagnostic tool in the diagnostic workup of patients with soft signs of arterial injury.
... This population-based study covered all knife and machete-related penetrating stab injuries that required hospitalization in Iceland over a recent 16-year period. The incidence of stab injuries requiring hospitalization in Iceland was very low (1.54 per 100,000 inhabitants), which is in line with other Nordic countries such as Finland (0.9 per 100,000 inhabitants) [10], but far lower than the much higher incidence reported in Australia (390 per 100,000 inhabitants) [23]. Furthermore, the incidence of stab injury requiring hospitalization in Iceland was relatively stable over time which is in line with recent studies from high-volume centres in Australia, but also Belgium, Sweden, and Finland [10,[24][25][26]. ...
... Generally,there has been a feeling of increased incidence of stab injuries in western societies, possibly as a result of media attention [9], but contrary to this belief, recent studies have shown that the overall incidence of such injuries does not appear to be increasing [3,18,24,26,27]. In fact, many studies have shown a decrease in incidence [18,23]. Thirty-day mortality in the present study was very low (4.1%), but our cohort represents a small population compared to previously reported series in the literature [3,24,25,27,28]. ...
Background
Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation.
Materials and methods
This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000–2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury.
Results
Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0–53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75).
Conclusion
Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.
... The most common complications in stab injuries after discharge are wound infections, followed by other potentially fatal complications [30]. In the present study, complications developed in 13 patients. ...
Background
Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED).
Methods
This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patient’s files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients.
Results
Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3% (n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement.
Conclusion
The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement.
... In the studies of Boström et al. with more than 1000 patients, the mortality rate was 3.4% (10) . Jacob AO et al. found mortality rate as 2.26% in their study, which included 1500 penetrating injury cases (11) . While the mortality rate was 5.6% in the study of Köksal et al., there was no mortality in our study. ...
... In the study performed by Jacob et al., the lower extremity was the most affected area in sharp object-based injuries. Of these, 16 were injured in the thigh, 13 in the chest, 5 in the neck, and 1 in the abdomen (15). In our study, 15 patients (39.4%) had the upper extremity injury including hand, wrist, arm and shoulder. ...
Background: Trauma and injuries are the most common reasons for presenting to emergency services. The aim of the present study was to comprehensively evaluate the injuries from gunshot and penetrating objects presented to the emergency department of Kafkas University Medical School Research Hospital along with the organ(s) effected and the degree of injury. It is crucial to determine the nature of the injury and the condition of the effected organ in order to refer the patients to the relevant branch for effective treatment. Materials and Methods: In this study, a total of 73 cases who were admitted between the years of 2017-2019 were examined retrospectively. For statistical analysis, a Windows-compatible IBM SPSS 20.0 package program was used. Results are expressed as mean ± standard deviation. Results: About 68 of them were male and 5 were female. The mean age was 33.85 and a majority of patients were comparatively young. Consultation was requested for about 44 patients. 44 patients were consulted by the relevant departments to determine and treat the condition of the injury and the condition in the organ it damaged. Six patients died due to gunshot wounds and one patient died due to sharp object-based injury. Conclusions: These studies will contribute to the development of new strategies to solve the social problem of individual armament. Because of the high mortality rate in penetrating injuries, patients should be diagnosed quickly and the necessary treatment should be initiated immediately.
... La relación entre las heridas de arma blanca y de fuego es superior a 3/2 en nuestro trabajo. El predominio de las heridas por arma de fuego sobre las heridas de arma blanca es habitual en la mayoría de las sociedades, con excepción de algunas particularidades como Alice Springs en Australia (Jacob et al, 2007) donde las heridas por arma blanca mostraron una relación 310/1 con las lesiones por arma de fuego. El 53% eran mujeres y la localización predominante fue el muslo (38%), vinculada a la tradición de castigos corporales. ...
Los accidentes de tránsito, las heridas por arma blanca y de fuego son las principales causas de lesiones en situación de emergencia urbana y la primera causa de muerte en personas de15 a44 años de edad, en el mundo. Incluimos 837 heridos por arma blanca, 1326 heridos por arma de fuego y 5331 pacientes lesionados en accidentes de tránsito, ingresados al Hospital de Urgencias de la ciudad de Córdoba. Utilizamos el conocimiento anatómico para la localización de las heridas y para la descripción de su severidad, las intervenciones quirúrgicas, las complicaciones, las secuelas y la mortalidad. Las heridas graves por arma blanca se localizaron principalmente en tórax (42%), el 90% de las cirugías fueron en abdomen y tórax, y el 75% de la mortalidad se debió a lesiones torácicas. Las heridas graves por arma de fuego se ubicaron predominantemente en cráneo (17%) y miembro inferior izquierdo (17%), pero el 39% de las intervenciones quirúrgicas fue en abdomen y el 45% de la mortalidad se debió a heridas en cráneo. Las lesiones graves causadas por accidentes de tránsito comprometieron el cráneo en 41% de los casos, el 65% de las operaciones fueron ortopédicas y el 70% de la mortalidad fue consecuente con traumatismo de cráneo. Las descripciones basadas en regiones anatómicas nos permiten contar con información de carácter general, interpretar aspectos médico-legales y, además, definir los recursos humanos y materiales necesarios para las instituciones que asisten emergencias. Este recurso no tiene proyección de tipo pronóstico.
Traffic accidents injuries, stab and firearm-related wounds are the main urban emergency injuries and the leading cause of death among people 15 to 44 years old, all over the world. This study involves 837 stab wounds, 1326 firearm-related wounds and 5331 traffic accident injuries, admitted at the Emergency Hospital of Cordoba city. Anatomic knowledge was the basement to locate the wounds, its severity, surgical procedures, complications, sequelaes and mortality. Serious stab wounds were mainly located in thorax (42%), 90% of surgeries were performed in abdomen and thorax, and 75% of fatal injuries were in thorax. Serious firearm-related wounds predominant location was head (17%) and left inferior limb (17%), but 39% of the surgical procedures were in abdomen and 45% of mortality was due to head wounds. Serious injuries caused by traffic accidents involved the head in 41% of the cases, 65% of surgeries were orthopaedic procedures and 70% of the mortality was by head injuries. Descriptions based on anatomic regions and elements facilitate access to general information, understanding of medico-legal aspects and determination of necessary human and material resources for institutions providing emergency assistance. This descriptive mode has not prognostic value.
... Detailed history from paramedics or witnesses can be helpful in determining whether the knife was intact after stabbing [1] . Commonest cause of stab injuries requiring admission are in increasing order: the chest, abdomen and neck, however cardiac injuries are rare and incidence is highest in middle age males [2,3,4] . The thorax has also been the site for most of the retained knife injuries [5] . ...
We report a 20-year-old boy presenting in OPD, after two and half month's history of assault and stab wound in left axilla with complaint of weakness and tingling in the left little and ring fingers. A knife blade retained in his chest wall was initially missed in emergency department. This case reminds us that, careful examination on all trauma patients is mandatory, especially those with penetrating injuries. Lack of apparent sign and symptoms, and a seemingly stable patient should not be an excuse for stopping further necessary assessment. Introduction A 20-year-old, average built male presented to the outpatient after two and half month's history of alleged assault with complaints of weakness and tingling sensation over his left little and ring finger for fifteen days. On examination patient was afebrile, vitals were stable. He was conscious, oriented and no other neurological deficit could be elicited, other systemic examinations was normal. Patient had well healed scar about 3 cm in his left axilla with no local signs of inflammation. After a detailed history it unfold that the scar was due to a stab injury two and half months back (Fig. 1). Treatment was done in primary center, however detail reports were not available with the patient. On performing a chest x-ray we found a broken knife blade on his left upper chest with no signs of hemopneumothorax or signs of parenchymal injury (Fig. 2). After admitting him to the hospital a CT thorax was done, which confirmed our diagnosis, there was no evidence of vascular, thoracic injury, pleural, bony or cardiac injuries in the CT scan. After detailed investigations we posted him for surgery. The knife was lying over the left chest wall and had not penetrated the pleura, a simple extraction of the blade was fortunately possible. The post-operative period was uneventful and he was doing well after 6 months of follow up without any neurological deficit.
... Većina pacijenata sa povredama leve subklavije i aksilarke se leče sa ovim tipom pristupa. »Trapdoor« ili »knjiga« incizija je vrlo retko potrebna i daje dodatni morbiditet i ima visoki rizik od komplikacija.[33,34]Kod desnostranih rana proksimalna kontrola sudova se radi lakše uz upotrebu medijalne sternotomije, uz uzdužno ili poprečno širenje cervikotomije izvedene za postizanje distalne kontrole sudova. ...
UDC 616-001
Medicina danas 2011;10(1-3):18-29
ABDOMINALNA HIRURGIJA-
TRAUMA
BIBLID 1451-124X:(2011);10(1-
3):18-29
PREGLEDNI NAUČNI RAD
TUPA TRAUMA – RETROPERITONEALNI HEMATOM
BLUNT TRAUMA – RETROPERITONEAL HAEMATHOMA
Veljković Radovan, Sečen Svetozar, Šarčev Katarina, Moljević Nebojša, Vuković Milivoje,
Protić Mlađan, Ivanov Dejan, Korica Milan, Rajkov Branislav, Bjelajac Dean, Petrović
Dejan.
Klinika za abdominalnu, endokrinu i transplantacionu hirurgiju, Klinički centar Vojvodine;
Novi Sad.
SAŽETAK
Cilj ovog rada je da se prikažu načini prezentacije, dijagnoze i lečenja retroperitonealnih
hematoma posle tupe traume tela. Retroperitonealni prostor sadrži mnogo različitih struktura koji
su delovi raznih sistema organizma. Klinička slika odgovara opštim simptomima iskrvarenja,
šoka, peritonitisa ili svakom organu ili sistemu pojedinačno. Klasifikacija još uvek nije jedinstvena
i može se koristiti nekoliko raspoloživih sistema klasifikacije povreda retroperitoneuma.
Dijagnostika retroperitonelnih hematoma ima opšte i posebne principe prema zahvaćenoj regiji.
Neoperativno lečenje može biti primenjeno kod lateralnih perirenalnih i nekih pelvičnih
retroperitonelnih hematoma. Ostali hematomi, supra i inframezokolični medijalni, lateralni
paraduodenalni, lateralni perikolični, portalni i retrohepatični bi
trebali biti otvoreni.
Ključne reči:
retroperitonealni hematom, tupa povreda, hirurgija, lečenje
SUMMARY
Aim of this work was to present the way of the presentation, diagnosys and treatment of the
retroperitoneal haemathomas after blunt trauma of the bod
y. Retroperitoneal space contain
many different structures of diversity organ sistems. Clinical picture respond to general
symptoms of exsanguination, schock, peritonitis, or each organ, or system individually.
Clasification is still unequal, and few available clasiffication system could be used. Diagnosis od
the retroperitoneal haemathoma has its general and special principles according to affected
area. Nonoperative treatment could be applied in lateral perirenal and certain pelvic
retroperitoneal haemathomas. Other haemathomas, supra and inframesocolic medial, lateral
paraduodenal, lateral pericolic, portal and retrohepatic should be opened.
Key words:
retroperitoneal haemathoma, blunt injury, surgery, therapy
... These trends are not surprising and have been widely reported in the literature. In most studies for penetrating injuries, the typical patient was a young middle-aged man accounting for 90% of affected victims.[511] It is widely accepted the majority of stabbing occurs in public places like streets and pubs. ...
To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period.
A retrospective review of collected data from the Hospital database was conducted. The database contains comprehensive medical records for all patients attended by the trauma team for deliberate stab injuries. It is updated by the surgical team after each admission. All patients with deliberate penetrating injury who were attended by the service between 1 January 2006 and 31 December 2008 were identified. Patients who died in the prehospital phase, those managed exclusively by the emergency department and limb injuries without vascular compromise were excluded from the study.
Six hundred and nineteen patients with stab injuries (following knife crime) from North London attended the Hospital in the above period. One hundred and thirty-seven paients required surgical admission. Two were cases of self-inflicted knife injuries. Over the 3-year period the percentage of victims below 20 years of age is increasing. Ninety-three percent of knife crime occured between 6 pm and 6 am; recently moving toward week days from weekend period.
The overall rate of penetrating injuries (stab injuries) is slowly declining. Timely cardiothoracic support facility is vital in saving lives with major cardiac stab injuries. Although alcohol drinking restriction has been lifted, most cases of stabbings are still occurring out-of-hours when surgical personnel are limited.
... Irrespective of the presence of a trauma system for Indigenous people, trauma will continue to be unavoidable in any remote and disadvantaged community relying on subsistence activities, while external health provision in such communities will always be in short supply. 116,117 However, some new potential initiatives may be of help, especially those derived from the experience of societies with limited resources. ...
Trauma systems have been shown to provide the best trauma care for injured patients. A trauma system developed for Indigenous people should take into account many factors including geographical remoteness and cultural diversity. Indigenous people suffer from a significant intentional and non-intentional burden of injury, often greater than non-Indigenous populations, and a public health approach in dealing with trauma can be adopted. This includes transport issues, prevention and control of intentional violence, cultural sensitization of health providers, community emergency responses, community rehabilitation and improving resilience. The ultimate aim is to decrease the trauma burden through a trauma system with which indigenous people can fully identify.
... It is a national disgrace. 3 Training our surgeons of the future has been a focus of much college activity of the last few years. Trauma training appears to pose a very unique challenge. ...
Aims
This commentary aims to address the critical shortage of surgeons in rural Australia and propose the development of a sustainable rural surgical training pathway. By examining current healthcare disparities and workforce challenges, it highlights the need for locally trained and retained rural surgeons to improve health outcomes and reduce healthcare inequities.
Context
Rural Australians experience significant healthcare disparities due to geographical isolation, lower socioeconomic status and limited availability of specialist care. The current model relies heavily on patient transfers to metropolitan centres, which are costly, logistically challenging and unsustainable. Current surgical training programmes offer some rural exposure; however, they remain metropolitan‐centric, resulting in fewer surgeons practising in rural areas.
Approach
A dedicated rural surgical training pathway is proposed to address this gap. It would focus on selecting candidates with a demonstrated commitment to rural practice and provide tailored training, mentorship and guaranteed rural placements. Training must align with the specific healthcare needs of rural communities. Additionally, initiatives like the rural health equity strategy and regional training hubs must be supported by structural changes in the selection process to prioritise rural trainees.
Conclusion
Addressing the shortage of rural surgeons is essential to improving healthcare equity. A rural surgical training pathway can aid in long‐term retention of surgeons in rural areas. This model supports both healthcare and economic sustainability, aligns with national rural health strategies and fosters stronger community connections. Investing in rural surgical training is a critical step towards reducing healthcare disparities and building a more resilient rural health system.
Background:
Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ.
Methods:
A five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021.
Results:
214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n = 81) and the chest/thorax (n = 77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n = 8), colon (n = 5) and stomach (n = 2), whilst the liver was the most frequently injured solid organ (n = 6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths.
Conclusion:
Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.
Sharp force injuries represent a major constituent of physical assaults and homicidal fatalities, especially in countries with strict firearm legislations. In forensic investigations, the examination of homicidal sharp force cases remains a challenge for both determining the cause and manner of a death. The aim of this study is to analyze the patterns of homicidal sharp force cases in Northern Tunisia. We perform a descriptive study with a retrospective data collection over an 11-year period (January 2007–December 2017). During the study period, 405 cases of homicidal sharp force casualties were observed. The mean age was 33.9 years, with a range of 2 months–89 years. We note a male predominance (male to female ratio of 4.7), most of who were single (91.2%). The casualties lived mainly in urban areas (68.4%) and were unemployed or daily workers in 61% of cases. Assaults occurred mainly during summer (52.4%) at weekends (38%) in a public place (62.4%) with essentially one perpetrator (68.6%) who was an acquaintance of the deceased in 32.6% of cases. The injuries were primarily located in the thorax (75%) and were associated with defensive wounds in the upper limbs. The most frequent cause of death observed was hemorrhage (82.9%). The analysis of patterns in homicidal sharp force cases allows us to construct specific preventive measures that target young males. Lesion analysis aids forensic specialists in following a thorough autopsy to determine the causes of death.
Background:
This investigation was undertaken to define the factors determining the optimal and most productive relationship among indigenous communities, surgeons, and providers of surgical services.
Methods:
A systematic literature review was conducted to identify studies reporting on the experience of indigenous communities with surgeons, medical practitioners, and the providers of surgical and other health services. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, including all literature available until the search date of April 3, 2019. The reference lists of all included articles and related review articles were searched manually to identify further relevant studies. An inductive approach was used to identify common themes.
Results:
Thirty-three publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 20), North American First Nation (n = 10), and Indigenous Latin Americans (n = 1). Across all indigenous peoples, 6 themes emerged: accessible health services, community participation and community governance, continuous quality improvement, a culturally appropriate and clinically skilled workforce, a flexible approach to care, and holistic healthcare.
Conclusion:
To provide medical and surgical services in indigenous communities successfully requires a diverse range of skills and core technical and academic competencies. Many skills lie within the definition of professionalism and advocacy as well as the ability to undertake and operationalize community consultation and empowerment. If surgical services serving Indigenous communities are to be successful in addressing health disparity, specific training in these skills will need to be developed and made available.
Existing risk assessment tools are not effective or sustainable in identifying Oil and Gas Extraction (OGE) workers at high risk of fatigue-related injuries or incidents. We developed a comprehensive Fatigue Risk Assessment and Management in high-risk Environments (FRAME) survey through an industry-academic participatory approach. The FRAME survey was developed through: (1) systematic gathering of existing fatigue scales; (2) refining the inventory using the Delphi Consensus technique; and (3) further refinement through employee/worker focus groups. The participatory approach resulted in a final FRAME survey across four fatigue dimensions—sleep, shiftwork, physical, and mental fatigue, and was composed of 26 items. The FRAME survey was founded on occupational fatigue science and refined and tailored to the OGE industry, through rigorous industry stakeholder input, for safer, effective, practical, and sustainable fatigue assessment and management efforts.
Central Australia is widely characterised as a frontier, a familiar trope in literary constructions of Australian identity that divides black from white, ancient from modern. However, recent anthropological and literary evidence from the Red Centre defies such a clear-cut representation, suggesting more nuanced ‘lifeworlds’ than a frontier binary can afford may better represent the region. Using walking narratives to mark a meeting point between Aboriginal and settler Australian practices of placemaking, this paper summarises and updates literary research by the author (2011–2015), which reads six recounted walks of the region for representations of frontier and home. Methods of textual analyses are described and results appraised for changes to the storied representation of Central Australia from the precolonial era onward. The research speaks to a ‘porosity’ of intercultural boundaries, explores literary instances of intercultural exchange; nuances settler Australian terms for place, including home, Nature and wilderness; and argues for new place metaphors to supersede ‘frontier’. Further, it suggests a recent surge in the recognition of Aboriginal songlines may be reshaping the nation’s key stories.
This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002–2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07–1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49–2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20–3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23–1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.
Thunderstorms are classic weather events. Huge electrical forces are involved, producing millions of amperes and phenomenal voltages within microseconds of time. Hundreds of deaths occur each year from atmospheric lightening stroke, especially in tropical countries. Understanding lightning related casualties is more than just reporting numbers of deaths. As death takes place immediately, no signs of vital reaction are to be expected in connection with bizarre presentations of victims and torn clothing further arouse suspicions of foul play and sometime person at a considerable distance from the spot of lightning, is killed with no mark of injury due to 'return shock' i.e. discharge of charged cloud induced electricity from his own body. More people are struck by lightning in hilly states blessed with heavy rains than in all other states on average both indoor and open fields. This article reveals a series of such cases brought to the Government Medical College, Haldwani.
Violence and abuse1 among Australias Aboriginal populations and communities, especially across Central Australia, have increasingly been the focus of government, academic, social and criminal justice, law enforcement and media reporting. Despite the weight of these reports and other evidence, such as the lengthy daily court lists of assault offences, there continues to be a culture, within both the Aboriginal and the non-Aboriginal community, of minimisation and blindness about the nature and extent of domestic or intimate partner-related family violence.2 The very private nature of most domestic and family violence incidents within a social and cultural environment that sanctions acts of aggression and violence contributes to the minimisation and blindness. This paper focuses on how problems such as domestic and family violence in Aboriginal communities in Central Australia can be better understood by examining specific domestic violence-related homicides that occurred between January 2000 and November 2008.3 The domestic-related homicides involved women and men, married and/or recognised by their families and the wider community as being married, from close and inter-related families in the remote cross-border communities of the Northern Territory, South Australia and Western Australia. From 1994 until 2006 I was involved in establishing and managing a program and service4 aimed at improving the protection and safety of Aboriginal women who experienced domestic violence in this region. I knew the victims, the offenders, and one or both of their families in eight of the homicides that occurred in that period.
The study involves two male Negroid adults with tailoring as the occupation working in
small scale industrial area of south Eastern, Nigeria who had a minor domestic misunderstanding. In a
bid of settling the rift the two were asked for sometime off to talk to each others privately.However,
the two agreed to talk over the issue within themselves; in one of this private meeting the said accused
took a pair of scissors in their office while they were talking suddenly stabbed the victim on the lateral
aspect of the left neck resulting to torrential bleeding.
The victim raised an alarm as he was rushed to a nearby clinic where he was attended by the medical
team and discharged. A few minutes later he died. This report tends to portend that all stab wound
notwithstanding the anatomical site must be hospitalised and monitored closely by both emergency
physicians and traumatic/neurosurgeons for a while before discharge.
Abstract
Acute Aluminum Phosphide (ALP) or Celphos poisoning is extremely lethal and invariably suicidal in nature. Unfortunately it’s high toxicity and absence of a specific antidote results in very high mortality. The key to treatment lies in rapid decontamination and early institution of resuscitative measures. It is a major cause of morbidity and mortality in northwest and central India. The outcome is poor, largely due to delay in appropriate management and skepticism amongst clinicians regarding the outcome. Things are further complicated by limited resources in tier 3 cities and villages where most of the cases present initially. ALP is commonly available and ingested in the form of Tablets / pellets of known amount and composition which renders a fair idea about the ingested dose of the poison. Surprisingly, in our case the victim ingested a massive dose of ALP powder to commit suicide. He could survive just because of instant and excessive vomiting, and meticulous management without any delay. Such an incidence with powder form of ALP is extremely rare and has not been reported so far, to the best of our knowledge.
Key Words: Celphos Powder, Aluminum Phosphide Poisoning, Phosphine
In Alice Springs, assault and attempted homicide, self-harm and attempted suicide and transportation accidents contribute substantially to the burden of disease, especially among the aboriginal population who are poor and disadvantaged. While road traffic accidents and self-inflicted injuries are the leading causes of injury-related deaths worldwide, violence is a major factor in Alice Springs trauma. Violence accounted for more than half the annual trauma case load. Aboriginal Central Australians bear a disproportionate risk of injury and illness compared to their non-aboriginal counterparts. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were 2,800 trauma admissions to Alice Springs hospital in 2006 compared to 1,800 admissions in 2003. Geographical location often limits timeliness, access and level of health care available to rural and isolated regions of central Australia. Solutions to the trauma epidemic in our Remote indigenous population must look past the Emergency and Surgical Departments that care for the injured to the individual, community, environmental, social and economic factors that underpin the traumas. Traumatic injury and death maybe the most preventable of all health issues. While tremendous resources are spent caring for injured patients in hospital, less attention is paid towards gaining a better understanding of injury prevention.
To evaluate the incidence, types of injury, medical consequences, and mortality of patients with stab wounds in Sweden.
Retrospective case study.
The Swedish National Hospital Discharge Register (SNHDR) and the Register of Causes of Death, Statistics Sweden (RCDSS) SUBJECTS: 1315 patients with stab wounds. All 1507 episodes were treated in Swedish hospitals from 1987-1994.
Incidence of stab wounds in Sweden, mortality, types of injuries and medical consequences.
From 1987 to 1994, 1315 people were admitted to Swedish hospitals with stab wounds, which corresponds to 2.1 injuries/100,000 population/year. In all, 1507 episodes were treated in hospital. There were 1121 men (85%) and 194 women (15%), with a median age of 32 years (range 1-88). The annual incidence was relatively constant during this period. The total number of deaths was 45/1315 (3.4%). Among these, 13 (29%) had thoracic, 9 (21%) abdominal, 7 (16%) head/neck and 7 (15%) extremity injuries. Twenty percent of those admitted to hospital had to spend more than one week there.
The incidence of stab wounds was low and the annual incidence stable. Young men in urban areas were the commonest victims. Injuries of the trunk were commonest, followed by injuries to the head and neck and limbs, 80% of the patients were discharged from hospital within a week, and 3% of those treated in hospital for stab wounds died.
The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined.
Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts.
In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the 'trauma team' group was 4/32 in 1995 compared with 7/33 in 1983.
Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non-significant decrease in length of stay and mortality in the 1995 cohort.
Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis.
Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA).
The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese.
This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.
Self-inflicted harm, whether by trauma or drug overdose, is not uncommon, and has important social consequences. This study was a retrospective record analysis of patients who presented to an emergency department after deliberate self-inflicted harm. Over the two-year study period, there were 175 self-inflicted trauma and 441 overdose presentations. The self-inflicted trauma patients were a heterogeneous group and included patients who displayed suicide-related behaviour and behaviour not related to suicide. The self-inflicted traumatic injuries tended to be either relatively minor or potentially very serious. Lacerations to the upper limb were seen most frequently. The trauma and overdose groups were almost mutually exclusive populations and showed some significant differences. The trauma group was smaller, contained a significantly greater proportion of younger patients and males, presented more commonly in the late evening and early morning hours and ultimately received less psychiatric counselling. Research of this type has problems of underreporting and data bias. Prospective studies of self-inflicted trauma would improve the identification of patients after self-harm and improve the understanding of the relationship between the patterns of injury psychiatric diagnosis and the long-term risk of future self-harm.
Three cases of traditional punishment in Central Australian Aboriginal men are presented in which the thighs were speared or stabbed as part of a "payback" system. In two cases, an unexpected effect of the stabbing or spearing was death due to severing of major leg vessels. The relationship between customary Aboriginal law and general law in Australia has not been clearly defined; however, these cases demonstrate that significant and untoward effects may result from traditional punishments. Pathologists working near traditional Australian Aboriginal communities may still encounter such injuries at autopsy.
To identify characteristics of patients who abscond from general hospital wards, and to determine patient outcomes.
Retrospective study.
In-patient wards of a public general hospital, Hong Kong.
Incident reports of 116 absconding episodes over a 20-month period from 1 November 1998 to 30 June 2000 were reviewed. Clinical characteristics, time and reason for absconding, destination of patient, outcomes, and adverse events were recorded.
The majority of patients who absconded were middle-aged males admitted through the Accident and Emergency Department to the specialty of general medicine. Most incidences occurred within 24 hours of admission while in the emergency admission wards. Twelve percent of incidents were repeated episodes of absconding. The most common clinical diagnoses given to this patient group were drug overdose, intoxication, and soft tissue injury. Known drug addicts (29.3%) formed a substantial proportion of the patient group. Forty- seven patients returned to the ward within a few hours, while a further nine (7.8%) re-attended the Accident and Emergency Department of the hospital within 4 days. Several adverse outcomes were recorded: one patient died following a fall from height and two patients committed criminal offences.
Patient absconding incidents are an important issue in hospital risk management. They can delay the delivery of appropriate medical treatment and may lead to other adverse patient outcomes, in addition to potential medicolegal consequences.
To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period.
Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was "assault".
Frequency of assault-related admission to hospital; demographic characteristics of the victims.
In the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25-34 years were most frequently hospitalised for assault, in a proportion greater than their proportion in the NT population. Females represented 59.7% of people admitted to ASH and 54.7% to TCH, greater than their proportion in the NT population. Aboriginals comprised 95.2% of ASH and 89.0% of TCH admissions, and were admitted in a significantly greater proportion than their proportion in the NT population (P < 0.001). The age-adjusted hospital admission rate resulting from assault has increased (P = 0.002) at an average rate of 1.6 (SE, 0.2) per 10 000 people per year. The proportion of assault-related admissions associated with alcohol has also increased significantly (P < 0.001).
The frequency of assault-related admissions to hospital, especially among the Aboriginal population, suggests that this major public health issue is escalating.
Self-inflicted abdominal stab wounds (ASWs) are uncommon. The present study aims to characterize the clinical profile of this unique group of psychiatric-surgical patients.
A retrospective review of 23 patients with intentional self-inflicted ASWs at two urban level I trauma centres during a 10-year period.
Most patients were males (70%), ages ranging from 21 to 82 years (mean 40 years). Seventy-four percent of patients had a previous psychiatric history and prior suicide attempts were common (41%). Half of the patients had a positive admission drug or alcohol screen. Hypotension (systolic blood pressure (SBP) < 90 mmHg) was present in only two patients. Mean injury severity, revised trauma and Glasgow coma scores were 5.8, 7.7 and 14.5, respectively. The most commonly used instrument was a knife (87%). There were 1.5 external wounds per patient located primarily in the right upper quadrant (40%) and right lower quadrant (23%). These were associated with extra-abdominal wounds in 22% of cases. Local wound exploration was positive in 15 patients (65%), who all underwent laparotomy. Injured intra-abdominal or retroperitoneal organs were identified in 10 patients and included the stomach, duodenum, small bowel, colon, mesentery, inferior vena cava (IVC) and psoas muscle with a mean of 1.7 injuries per patient. Wound infection was the only post-operative complication (two patients). All eight patients with a negative local wound exploration were observed without complication. Seventy percent of patients were ultimately transferred to a psychiatric ward with a mean length of stay on the surgical service of 8 days. Only one patient died during admission due to metastatic malignant disease.
Self-inflicted ASWs in suicidal patients can induce significant although most likely non-lethal abdominal and retroperitoneal injuries. This observation should guide the trauma surgeon when treating such patients.
Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre.
Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed.
Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15-82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed - laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1-107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination.
Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.