Knife and Stab Wounds in the University Hospital Schleswig-Holstein

A Retrospective Evaluation of Medical Documentation from the Emergency Department

Following an increase in knife attacks in Germany in the summer of 2024, the German Bundestag has imposed stronger regulations on the carrying of knives in public (1). There are currently scant valid data in Germany on the need for treatment due to penetrating trauma from stab or cut wounds.

The aim of this epidemiological study was to characterize in more detail the frequency of emergency admissions to the two emergency departments belonging to the University Hospital Schleswig-Holstein (UKSH) due to stab and cut wounds from knives between 2020 and 2024.

Methods

All medical documentation from the emergency departments between 1 January 2020 and 30 November 2024 was retrospectively analyzed at the Kiel and Lübeck sites of the UKSH. The terms “Stich” (stab), “Schnitt” (cut), and “Messer” (knife) combined with “ODER” (or) were used as search criteria. By reading medical history forms, five different reviewers were able to eliminate keywords that had been incorrectly recorded, whereby each dataset was analyzed by only one reviewer.

The following variables were also included: the object used in the offense, the mechanism of injury, where the injury took place, the relationship to the perpetrator, and the influence of alcohol. Pfanzagl’s frequency trend analysis was used to identify whether there was a change over time. To determine statistical significance, a nominal significance level of 0.05 was chosen.

Results

A total of 367 684 datasets were searched for the abovementioned criteria and 8055 relevant datasets retrieved. There were 1000 datasets that were not related to stab or cut wounds, while 1132 datasets related to self-inflicted injuries. A total of 5564 (78.9% of all stab and cut wounds) were categorized as accidental and 309 (4.4%) as injuries caused by external force, 177 (2.5%) of which involved external force with a knife used as the object to commit the act.

In the subgroup of patients with external force injury in whom a knife of any type was used (Table), the victims were mostly young (33.1 ± 12.7) and male (92.1%), with 23.7% being intoxicated. In 51.4% of cases, the patients arrived at the emergency department between 10:00 pm and 8:00 am; 86.4% were accompanied by the emergency services. Those responsible for the injury often belonged to the victim’s family, circle of acquaintances, or peers (28.2%), and in 22% of cases, the location at which the injury occurred was a private home. In the group of individuals injured by knives, 44.6% were admitted via the emergency room, approximately 55.4% remained as inpatients, 13.6% were treated in an intensive care unit, and two people died from their injuries (1.1%).

Table

Characterization of the subgroup of external-force stab and cut wounds inflicted with knives*

The median Injury Severity Score (ISS) was 9 (25^th percentile 4; 75^th percentile 13), with 42 (24.3%) of the patients having a score greater than or equal to 16.

No clear upward or downward trend over time could be seen between the first quarter (Q1) of 2020 and the third quarter (Q3) of 2024 (Figure) (p = 0.058). Extrapolating the cases in 2024 to the rest of that year yields a maximum value of 52 cases/year compared to the average in 2020–2023 (31 cases/year), which also reaches statistical significance in the frequency trend analysis (p = 0.007).

Figure 1

Number of external-force injuries inflicted with knives in the period from Q1 2020 to Q4 2024

Discussion

The German Police Crime Statistics indicate a rise in knife attacks between 2021 and 2023, but do not differentiate between the carrying out of an attack and threats with a knife (2). In 2023, the trauma registry of the German Society of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie) showed a somewhat higher percentage of penetrating injuries (4.4%) out of all registered cases compared to the 10-year average (4.0%), but no distinction is made according to injuries caused by knives (3). A study conducted in the the greater Düsseldorf area showed a low incidence of stab wounds with a higher proportion of minor injuries (4).

We were able to show that likewise in the state of Schleswig-Holstein, knife injuries caused by external force are a rare type of injury that plays only a minor role for emergency departments in terms of numbers. We identified an average of around 31 cases per year in the emergency departments between 2020 and 2023. Studies conducted in the Düsseldorf metropolitan region between 2015 and 2019 found that emergency services treated approximately 50 penetrating knife injuries every year (4). The frequency of injuries caused by knife attacks in the Düsseldorf cohort did not clearly and continuously rise between 2015 and 2019 (4). The same applies to Schleswig-Holstein for the years between 2020 and 2023. The high figure for 2024 described here is compatible with, but not proof of, an acute rise in the number of injuries caused by external force with a knife in 2024 and achieves statistical significance in the frequency trend analysis.

The patient cohort in this study was comparable to the analysis conducted in Düsseldorf (4), heterogeneous with regard to the severity of the injury, but also including a not insignificant percentage of patients with severe injuries, such that over 10% of patients with knife injuries required treatment on an intensive care unit and the mortality rate in this cohort was over 1%.

Given that a relevant proportion of stabbings occur in the private domain, a ban on knives in public spaces does not appear to be the right approach to preventing such attacks in at least a quarter to a third of all cases. However, at least in terms of the math, a ban of this type has the potential to reduce stabbings and avoid serious injuries in just over half of cases. What effect an absolute ban on knives in public spaces would have cannot be estimated on the basis of the current data.

Domagoj Schunk, Lena Unger, Denise Peters, Sascha Thielke, Alina Balandin, Jan-Niclas Kersebaum, Andreas Paech, Andreas Seekamp, Sebastian Wolfrum

Interdisziplinäre Notaufnahme und Kindernotaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany (Schunk, Peters, Kersebaum) [e-mail]

Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany (Unger, Wolfrum)

Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany (Paech)

Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany (Seekamp)

UKSH Gesellschaft für IT Services mbH, Universitätsklinikum Schleswig-Holstein, Germany (Thielke)

Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany (Balandin)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript submitted on 24 October 2024, revised version accepted on
17 December 2024.

Translated from the original German by Christine Rye.

Cite this as
Schunk D, Unger L, Peters D, Thielke S, Balandin A, Kersebaum J, Paech A, Seekamp A, Wolfrum S: Knife and stab wounds in the University Hospital Schleswig-Holstein: A retrospective evaluation of medical documentation from the emergency department. Dtsch Arztebl Int 2025; 122: 79–80. DOI: 10.3238/arztebl.m2024.0256

References

1. www.bmi.bund.de/SharedDocs/kurzmeldungen/DE/2024/10/bt-sicherheitspaket.html

2. https://de.statista.com/statistik/daten/studie/1471312/umfrage/messerangriffe-in-deutschland/

3. www.auc-online.de/fileadmin/AUC/Dokumente/Register/TraumaRegister_DGU/TR-DGU-Jahresbericht_2024.pdf

4. Schürmann J, et al.: Anaesthesiologie 2024; 73: 444–5