Violence-related knife injuries in a UK city; epidemiology and impact on secondary care resources

Nabeela S Malik; Beau Munoz; Cynthia de Courcey; Rizwana Imran; Kwang C Lee; Saisakul Chernbumroong; Jonathan Bishop; Janet M Lord; George Gkoutos; Douglas M Bowley; Mark A Foster

doi:10.1016/j.eclinm.2020.100296

Violence-related knife injuries in a UK city; epidemiology and impact on secondary care resources

EClinicalMedicine. 2020 Mar 3:20:100296. doi: 10.1016/j.eclinm.2020.100296. eCollection 2020 Mar.

Authors

Nabeela S Malik^{1

2

3

4}, Beau Munoz^{1

5}, Cynthia de Courcey^{1

2}, Rizwana Imran^{1

2}, Kwang C Lee^{1

2}, Saisakul Chernbumroong^{1

6}, Jonathan Bishop¹, Janet M Lord^{1

3}, George Gkoutos^{1

6

7

8}, Douglas M Bowley^{1

2

9}, Mark A Foster^{1

2

9}

Affiliations

¹ NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom.
² University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.
³ College of Medical and Dental Sciences, Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom.
⁴ 212 Field Hospital (Volunteers), Encliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, United Kingdom.
⁵ Uniformed Services University (USU) Surgical Critical Care Initiative (SC2i), Walter Reed National Military Medical Center (WRNMMC), Bethesda 20889, Maryland, United States.
⁶ College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
⁷ Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom.
⁸ MRC Health Data Research UK (HDR UK), United Kingdom.
⁹ Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.

Abstract

Background: The incidence of knife-related injuries is rising across the UK. This study aimed to determine the spectrum of knife-related injuries in a major UK city, with regards to patient and injury characteristics. A secondary aim was to quantify their impact on secondary care resources.

Methods: Observational study of patients aged 16+ years admitted to a major trauma centre following knife-related injuries resulting from interpersonal violence (May 2015 to April 2018). Patients were identified using Emergency Department and discharge coding, blood bank and UK national Trauma Audit and Research prospective registries. Patient and injury characteristics, outcome and resource utilisation were collected from ambulance and hospital records.

Findings: 532 patients were identified; 93% male, median age 26 years (IQR 20-35). Median injury severity score was 9 (IQR 3-13). 346 (65%) underwent surgery; 133 (25%) required intensive care; 95 (17·9%) received blood transfusion. Median length of stay was 3·3 days (IQR 1·7-6·0). In-hospital mortality was 10/532 (1·9%). 98 patients (18·5%) had previous attendance with violence-related injuries. 24/37 females (64·9%) were injured in a domestic setting. Intoxication with alcohol (19·2%) and illicit drugs (17·6%) was common. Causative weapon was household knife in 9%, knife (other/unspecified) in 38·0%, machete in 13·9%, small folding blade (2·8%) and, unrecorded in 36·3%.

Interpretation: Knife injuries constitute 12·9% of trauma team workload. Violence recidivism and intoxication are common, and females are predominantly injured in a domestic setting, presenting opportunities for targeted violence reduction interventions. 13·9% of injuries involved machetes, with implications for law enforcement strategies.