Penetrating trauma is an injury caused by a foreign object piercing the skin, which damages the underlying tissues and results in an open wound. The most common causes of such trauma are gunshots, explosive devices, and stab wounds. Depending on the severity, it can be a puncture wound (sharp object pierces the skin and creates a small hole without entering a body cavity, such as a bite), a penetrating wound (a sharp object pierces the skin, creating a single open wound, AND enters a tissue or body cavity, such as a knife stab), or a perforating wound (object passes completely through the body, having both an entry and exit wound, such as a gunshot wound).

The most common causes of penetrating trauma in the US are gunshots and stabbings. One recent study found approximately 40% of homicides and 16% of suicides by firearm involved injuries to the torso.1 As recently as 2003, the US led in firearms-related deaths in all economically developed countries.2

A 2010 study of 157,045 trauma patients treated at 125 US trauma centers found the incidence of penetrating trauma to be significantly less than blunt trauma. Only 6.4% of all injuries were gunshots, while 1.5% were stab wounds.3 Yet, significant geographic variations and racial differences in the incidence of penetrating trauma exist. In a Los Angeles study of 12,254 trauma patients, 24% of patients treated had sustained penetrating trauma. In a similar Los Angeles study, penetrating trauma accounted for 20.4% of trauma cases, yet resulted in 50% of overall trauma deaths—most of which were due to gunshot wounds.4 Hence, the precise incidence of penetrating chest injury varies depending on the urban environment and the nature of the review. Overall, reported findings show penetrating chest injuries account for 1% to 13% of trauma admissions, and acute exploration is required in 5% to 15% of cases; exploration is required in 15% to 30% of patients who are unstable or in whom active hemorrhage is suspected.5

Demographics

Although hospital and emergency department visits for penetrating injuries are a small proportion of total visits (<1%), in 2013 there were 76,000 hospital discharges and 290,400 emergency department (ED) visits with an external cause of injury defined as assault by firearms, explosives, or cutting/piercing instrument. Cutting/piercing instruments were identified for about two-thirds of the injuries (45,500 hospital discharges and 19,300 ED visits). Most of the remaining cases listed a firearm cause. (Reference Table 5B.7.1 PDF CSV)

Males constituted a majority of persons with penetrating injuries, particularly when caused by firearms (88%) and explosives (80-85%). Two-thirds of penetrating injuries (66%-67%) occurred to persons age 18-44, even though this age group represents on 36% of the population. Residents in the South region had slightly higher rates of penetrating injuries than representative of its population. (Reference Table 5B.7.1 PDF CSV)

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Looking at a five-year trend for penetrating injuries by race shows black, non-Hispanics carry a larger share of firearms injuries than expected for the population share, but only a slightly higher share of injuries caused by explosives or cutting/piercing instruments. (Reference Table 5B.7.3 PDF CSV)

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Economic Burden

Hospital charges to treat injuries from firearms ($102,300) and explosives ($12,600) are much higher, on average, than the cost for all musculoskeletal injuries or all hospital discharges. Average charges for stabbing injuries ($35,400) are lower than for other causes of hospital stay. Overall in 2013, penetrating injuries accounted for $4.8 million in hospital charges. (Reference Table 5B.7.2 PDF CSV)

• 1. Nishimura T, Sakata H, Yamada T, et.al. Different Patterns in Abdominal Stab Wound in the Self-Inflicted and Assaulted Patients: An Observational Analysis of Single Center Experience. Kobe J Med Sci. 2017 Jul 20;63(1):E17-E21.
• 2. Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: Comparing the United States with other high-income countries, 2003. J Trauma. 2011;70:238–243.
• 3. Glance LG, Osler TM, Dick AW, et al. The survival measurement and reporting trial for trauma (SMARTT): Background and study design. J Trauma. 2010;68:1491–1497.
• 4. Hodnicj R. Penetrating trauma wounds challenge EMS providers. JEMS; https://www.jems.com/articles/print/volume-37/issue-4/patient-care/penet... . Accessed February 21, 2019.
• 5. Karmy-Jones R, Namias N, Coimbra R, et.al. Western Trauma Association critical decisions in trauma: penetrating chest trauma. Trauma Acute Care Surg;77(6);994-1002.