Research letter
Stab Wounds at a Maximal-Care Trauma Center
Incidence from 2015 to 2024
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In a study published back in 2023 by our supraregional trauma center, we already reported a rise in the number of stab wounds treated between July 2015 and December 2021 (1).
The German Police Crime Statistics (Polizeiliche Kriminalstatistik, PKS) for Berlin show a similar picture over a number of years. In 2023, 8.6% more cases of bodily harm were recorded compared to the previous year. Of particular note here is the significant rise in the number of cases of dangerous and grievous bodily harm in public spaces (17.5%) as well as the use of knives as crime weapons (5%) (2). The real number of these injuries is unknown since stab wounds are not subject to mandatory reporting by the healthcare facilities providing treatment.
Based on our observations during the 2024 treatment year, this article aims to provide an overview of the marked rise in the number of stab wounds treated at our center.
Methods
The Ethics Committee of the Charité – University Hospital Berlin, Germany, granted approval for the study to be conducted. The study included all individuals with injuries admitted via the emergency department at the Campus Virchow Klinikum of the Charité University Hospital Berlin with a stab wound inflicted with a knife between 01.07.2015 (when systematic documentation began) and 30.09.2024. Only those injuries requiring a level of treatment intensity that went beyond basic general and emergency medical care (for example, outpatient treatment for cutaneous and subcutaneous wounds) and that were seen by the specialist trauma surgery service were considered. Accidental injuries that could be plausibly verified as such were excluded. The data of the individuals with injuries were analyzed on the basis of a retrospective chart review (SAP ERP 6.0 EHP4, SAP AG, Walldorf, Germany). The data were processed descriptively and presented in graph form using GraphPad Prism (GraphPad Prism 10 for Mac OS, Version 10.2.3, GraphPad Holdings, LLC, San Diego, CA, USA). The rise in the incidence of injuries was examined by means of a frequency trend analysis according Pfanzagl.
Results
During the study period, a total of 433 stab wounds were recorded. As already published (1), the incidence of injuries showed a slight upward trend in the 2015–2020 period, with 19–44 stab wounds. The first marked increase was seen in 2021 (1), when 55 stab wounds were treated. In 2022 and 2023, the incidence remained at a consistently high level, rising again noticeably in 2024 without there being any known changes in the referral practices of the emergency services or in social structure. In the period from January to September 2024, 74 stab wounds had already been treated at our center. The increase in the number of individuals with injuries during the study period was significant (p < 0.01). The Figure shows the distribution of the annual injury frequency for the 2015–2024 period.
The majority of individuals with injuries (55% on average) presented to the hospital at night (8:00 pm to 8:00 am), whereas 45% presented during the day (8:00 am to 8:00 pm). Thoracoabdominal injuries predominated over the course of the study period. In 2024, 46% of all injuries were to this region, 33% to the extremities, and almost 11% each to the head and neck region. The Table shows the sociodemographic characteristics of those treated for injuries.
All individuals that died during the study period had already developed circulatory instability by the time the emergency services arrived or had no measurable cardiac activity and were transported to our hospital while undergoing resuscitation. Whereas an emergency thoracotomy was performed on one patient in the prehospital setting, emergency thoracotomy and, depending on the findings, laparotomy were performed on the other five individuals with injuries as part of their emergency trauma room treatment. One person survived the emergency trauma room phase, but subsequently died due to hypoxic ischemic brain injury. The other five deceased individuals did not survive the emergency trauma room phase. Injury victims who reached the emergency trauma room before being in extremis and who required surgical care always received interdisciplinary surgical care.
Discussion and conclusion
During the investigated period from 2015 to 2024, a significant rise was observed at the study center in the number of stab wounds requiring treatment. Despite its limitations regarding the unknown number of cases and the recording system, this observation is in line with the known number of cases shown in the PKS. While this injury etiology has been known for many years outside Europe (3), within Europe, it has been reported primarily in the United Kingdom (4). Our data confirm, for the first time, a comparable increase in penetrating injuries at a maximal-care trauma center in Berlin, Germany. However, it is not possible at present to conclusively assess either the causes of this trend or the implications for society, the healthcare system, or the professional groups involved (5).
A limiting factor worthy of note is that the data were not adjusted for the positive population trend in Berlin. In addition, data collection was retrospective and monocentric. Finally, while the Berlin Fire Department’s procedural instructions are publicly available, their recommendations regarding referral strategy are not. However, we are not aware of any official changes to the recommendations on referral strategy that would impact dynamics in terms of case numbers.
Marcel Niemann*, Alexander Sklavounos*, Moritz Mewes, Jerome Weber, Tobias Lindner, Tomasz Dziodzio, Wenzel Schöning, Ulrich Stöckle, Sijia Zhou, Tazio Maleitzke, Vera Jaecker
*These authors share first authorship.
Conflict of interest statement
The authors declare that no conflict of interests exists.
Manuscript submitted on 9 August 2024, revised version accepted on 30 October 2024.
Translated from the original German by Christine Rye.
Cite this as
Niemann M, Sklavounos A, Mewes M, Weber J, Lindner T, Dziodzio T, Schöning W, Stöckle U, Zhou S, Maleitzke T, Jaecker V: Stab wounds at a maximal-care trauma center—incidence from 2015 to 2024. Dtsch Arztebl Int 2025; 122: 77–8. DOI: 10.3238/arztebl.m2024.0235
Berlin Institute of Health der Charité – Universitätsmedizin Berlin, Julius Wolff Institut, Berlin, Germany (Niemann, Dziodzio, Zhou, Maleitzke)
Charité – Universitätsmedizin Berlin, Abdominalchirurgie, Chirurgische Klinik, Berlin, Germany (Sklavounos, Schöning)
Charité – Universitätsmedizin Berlin, Bereich Notfall- und Akutmedizin/ZNA, Berlin, Germany (Lindner)
Charité – Universitätsmedizin Berlin, Exzellenzzentrum für Thoraxchirurgie, Chirurgische Klinik, Berlin, Germany (Dziodzio)
Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark (Maleitzke)
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Maleitzke)
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