Journal Information
Original article
Available online 26 March 2025
Penetrating trauma in Spain: analysis of the Spanish trauma registry (RETRAUCI)
Traumatismo penetrante en España: análisis del registro español de trauma en UCI (RETRAUCI)
Judit Gutiérrez-Gutiérreza,
Corresponding author
, Jesús Abelardo Barea-Mendozaa, Carlos García-Fuentesa, Juan Antonio Llompart-Poub, Begoña Guardiola-Graub, Mikel Durán-Suquíac, María Ángeles Ballesteros-Sanzd, Javier González-Robledoe, Lluís Serviá-Goixartf, Cristina Méndez-Benegassi Cidg, Jose Maria Toboso Casadoh, Mario Chico-Fernándeza, on behalf of the Neurointensivism and Trauma Working Group of the SEMICYUC
a Servicio de Medicina Intensiva, UCI Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servei de Medicina Intensiva, Hospital Universitari Son Espases, Balearic Islands, Spain
c Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain
d Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
e Servicio de Medicina Intensiva, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
f Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lleida, Spain
g Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, Spain
h Servei de Medicina Intensiva, Hospital Universitari Germans Trias i Pujol, Barcelona
Received 16 September 2024. Accepted 20 January 2025
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Tables (2)
Table 1. Characteristics of the study population. Comparison of major demographic and clinical variables in blunt trauma cases.
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Table 2. Factors associated with mortality in penetrating trauma. Multivariate Model (AUROC 0.95).
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Abstract
Objective

To describe the epidemiology of penetrating trauma, mortality associated factors and its management in Spanish intensive care units.

Design

Multicenter, prospective registry. A comparison is established between two cohorts defined by the type of trauma (blunt and penetrating).

Patients

Patients with traumatic injury admitted to the participating ICUs from June 2015 to June 2022.

Interventions

None.

Main variable of interest

Epidemiology, injury pattern, prehospital and hospital care, resource utilization, and clinical outcomes.

Results

12,806 patients were eligible, of whom 821 (6.4%) suffered penetrating trauma; 418 patients (50.9%) from stab wounds, 93 (11.3%) from gunshot wounds, and 310 (37.8%) from other objects. The most common intent was assault (47.7%). The mean ISS was 15.2 ± 10.6 in penetrating trauma and 19.8 ± 11.9 in blunt trauma (p < 0.001). ICU mortality was 7.8% compared to 11.7% in blunt trauma, with deaths more frequently occurring within the first 24 hours (64% vs. 39%). Factors associated with mortality included female sex, prior use of antithrombotic agents, older age, higher NISS score, and the presence of cranial trauma or shock.

Conclusions

Penetrating trauma is an emergent pathology in our context with high complexity, highlighting the need for focused study and documentation, protocol development, and resource optimization to provide quality care.

Keywords:
Penetrating wounds
Gunshot wound
Stab wound
Mortality
Epidemiology
Resumen
Objetivo

Describir la epidemiología del trauma penetrante, los factores asociados a mortalidad y su manejo en unidades de cuidados intensivos españolas.

Diseño

Registro multicéntrico y prospectivo. Se establece una comparativa entre dos cohortes definidas por el tipo de trauma (contuso y penetrante).

Pacientes

Pacientes con enfermedad traumática que ingresan en las UCI participantes de junio 2015 a junio 2022.

Intervenciones

Ninguna.

Variable de interés principal

Epidemiología, patrón lesional, atención prehospitalaria y hospitalaria, consumo de recursos y resultados clínicos.

Resultados

12806 pacientes fueron elegibles, de los cuales 821 (6,4%) sufrieron un trauma penetrante; 418 pacientes (50,9%) por arma blanca, 93 (11,3%) por arma de fuego y 310 (37,8%) por otro objeto. La intencionalidad más habitual fue la agresión (47,7%). La media de ISS fue de 15,2 ± 10,6 en trauma penetrante y de 19,8 ± 11,9 en trauma contuso (p < 0,001). La mortalidad en UCI fue del 7,8% frente al 11,7% en trauma contuso, siendo más frecuente el fallecimiento en las primeras 24 h (64% frente al 39%) en el grupo de traumatismo penetrante. Los factores que se asociaron a mayor mortalidad fueron el sexo femenino, la toma previa de antitrombóticos, la edad, mayor puntuación en la escala NISS y la presencia de traumatismo craneal o shock.

Conclusiones

El trauma penetrante supone una patología emergente en nuestro entorno y con alta complejidad, por lo que es necesario incidir en el estudio y registro de la patología, protocolización y optimización de recursos para ofrecer una atención de calidad.

Palabras clave:
Herida penetrante
Arma de fuego
Arma blanca
Mortalidad
Epidemiología

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