knives

Death rate from handgun, long guns and knife wounds

tlambert — Thu, 13 Mar 1997 04:57:09 +0000

Death rate from handgun, long guns and knife wounds

Peter Proctor wrote:

An equivalent wound is ( by definition ) an equivalent wound .
Absent LET effects, it doesn't matter much where it came from.

Oh, so your statement was a tautology? By "equivalent", you meant of
equivalent lethality?

Hole, I meant an equivalent hole. Pretty simple concenpt, actually.
Surprised I have to explain it so many times...

Because it's ambiguous and the meaning you seem to be using is
not germane to the discussion. The important question is what the
result of substituting knives or long-guns for handguns in shootings
and stabbings. Will there bo more deaths, fewer deaths or about the
same number? To this end one should look at the overall death rate
from knife injuries and compare it with that for gunshot injuries.
Guns turn out to be four times as lethal as knives. Of course, part
of this difference could be due to the intent of the attacker, that
is, knife wound mortality could be low because many attackers
deliberately inflict superficial wounds. So we should also compare
mortality for multiple penetrating wounds to the torso, which would
seem to indicate some serious attempt to kill. For these sorts of
wounds guns are still 3-5 times as lethal. Finally we can check with
mortality rates for wounds to the same body structure (e.g penetrating
heart wounds). We see the same pattern once again.

Further, because of their
nature, it is considerably easier to shoot yourself with one kept loaded than
it is with a handgun. But you probably don't understand how that could be

Nope. Enlighten me. How is it easier to accidently shoot oneself in
the trunk with a long gun?

E.g..: With the exception of external hammer guns, a long gun is
inherently cocked when there is a round in the chamber. So, all that is
between you and an accidental discharge is a safety and a 3-6 pound trigger.
A revolver or a double action autoloader requires typpically a 12-15 pound
pull to discharge in double action.

You didn't answer the question I asked.

The rate was declining faster before handgun ownership increased.
Canada had a similar decrease without the handguns. Other factors
would seem to be much more important.

I haven't seen your figures, but from other threads, I gather that you have
had some difficulty getting statistical support for some of your contentions.

You are mistaken.

Here, again, are the numbers

Table 2.1 of Kleck's "Point Blank" shows that handgun sales jumped
dramatically around 1965 --- from around 0.5M per year to 1-2M per year
afterwards. This is presumably the reason for the increase in the
percentage of households owning handguns from 16% in the early sixties
to 25% in the late eighties. (Table 2.2 of Kleck)

Table 7.1 of Kleck shows that the fatal gun accident rate declined
from 2.4 per 100k population in 1933 to 1.21 in 1965 and then to 0.57
in 1987. That is a decrease of 1.19 before handgun ownership
increased, and a decrease 0.64 afterwards. The rate of decrease was
slower after 1965 than before.

Greg Booth said:

From Phil Ronzone's rkba.002 (US rates converted to rate per 100,000)
from U.S. Bureau of the Census, Statistical Abstract of the United
States: 1989 (109th edition.) Washington, DC, 1989.
and Canadian rates from the Canadian Centre for Health Information.

Year   US accident rate   Canadian accidental rate.
1969  1.139               0.63
1970  1.174               0.61
1971  1.136               0.66
1972  1.163               0.47
1973  1.235               0.56
1974  1.222               0.55
1975  1.103               0.49
1976  .944                0.39
1977  .900                0.43
1978  .811                0.38
1979  .890                0.30
1980  .858                0.31
1981  .813                0.25
1982  .755                0.23
1983  .722                0.17
1984  .704                0.24
1985  .689                0.25
1986  .662                0.20
1987  .574                0.23
1988                      0.23
1989                      0.29
1990                      0.25
1991                      0.24

tlambert Wed, 03/12/1997 - 23:57

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knives

Death rate from handgun, long guns and knife wounds

tlambert — Mon, 03 Mar 1997 11:15:40 +0000

Death rate from handgun, long guns and knife wounds

Peter H. Proctor writes:

E.g., the original issue was whether Pistols are
much less deadly than long guns because pistol fatalities are mostly
proportional to the size of the permanent wound channel.

Doubly wrong. First, the issue addressed by my cites is your claim
that handgun and knife wounds are equally deadly. You have yet to
offer the slightest scrap of evidence for this claim. Second, you
continue to go on with theories explaining why your claim is true.
Unfortunately, your theories do not agree with actual observations of
the real world. Should we modify the theories or the observations?

Thus, they kill
by roughly the same mechanism as edged weapons such as knives.

So? Are you seriously trying to argue that this means that the
mortality rate is the same???? How do you explain the fact that it is
different?

This is in contrast to rifle rounds which can actually
shatter tissue.

Sometimes. How important is this factor compared to all the other
factors that determine mortality? You'd have to actually look at case
fatality rates to figure this.

You quoted a JAMA article out of context re the unimportance of high linear
energy transfer in gunshot wounds, implying this meant long gun wounds.
In fact, If memory serves, this paper primarily concerned pistol wounds,
making the very point I was trying to make in the first place.

You really are full of it today, aren't you? Anyone who is under the
misapprehension that Dr Proctor has the slightest shred of credibility
can check JAMA v259 p2733. In the section on the misconception
'"Kinetic Energy Transfer" as a Wounding Mechanism' Fackler talks
about the "temporary cavity generated by the AK-74 rifle bullet" and
the "temporary cavity produced by the M16". Apparently Dr P believes
that the AK-74 and the M16 are pistols.

While I don't do many autopsies these days, I trained at a hospital
that has one of the largest transplant services in this part of the
US. This goes hand in glove with the path department doing a lot of
autopsies on people dying from all sorts of trauma--- from gunshot
wounds thru automobile accidents.

I see. The survival rate from the knife wounds and pistol wounds that
you autopsied was the same, so you infer that the survival rate for
knife wounds and pistol wounds in general is the same.

Frankly, I'd be more inclined to trust the opinion of a physician who
had treated some live patients. I talked to a friend who saw quite a
few knife and gun-shot wounds when he worked at an inner-city
hospital. He told me that that knife wounds were much less serious
since knives tend to push vital organs out of the way while bullets
tend to plough straight in.

I know bullshit when I see it....

Me too. It usually follows the phrase "If memory serves".

tlambert Mon, 03/03/1997 - 06:15

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knives

Death rate from handgun, long guns and knife wounds

tlambert — Mon, 24 Feb 1997 00:26:03 +0000

Death rate from handgun, long guns and knife wounds

Peter H. Proctor writes:

> 2) The main factor was apparently the substitution of handguns for
> long guns as home defense weapons. For penetrating trunchal
> wounds, the mortality rate for handguns is 15-20 %, roughly the
> same as for equivalent knife wounds. For (e.g) shotguns, the
> mortality rate is 70% or so. If memory serves, for high power
> rifles, about 30-40 %, BTW, the mortality rate from those wicked
> "assault weapons" is close to that for handguns, since they shoot
> a relatively low-powered round

Please provide a source for these claims.

> This is what I was taught in my training as a pathologist and seem
> to be pretty standard figures. Also, I saw roughly these figures
> presented at a Path convention and see no reason to question them.
> But I suppose I could find the reference somewhere.

Please do so. I've appended about 20 studies that all contradict this.

I looked in Medline for studies on gun shot and stab wound mortality
and turned up dozens. There was a consistent pattern across
different countries and wound locations -- gunshot wounds were far
more lethal. For example a study in The Journal of Trauma (36:4
pp516-524) looked at all injury admissions to a Seattle hospital over
a six year period. The mortality rate for gunshot wounds was 22%
while that for stab wounds was 4%. Even among patients that survived,
gunshot wounds were more serious -- the mean cost of treatment for
these patients was more than twice that for stab wounds.

> Apples and Oranges. I suspect the difference is " for equivalent
> trunchal wounds" which I carefully specified.. If you include
> superficial knife wounds and wounds that do not penetrate the
> peritoneum, your figures do sound about right. These are easy to
> treat and nobody ever dies from them.

Sorry, as I specifically stated those rates were for wounds serious
enough to warrant hospital admission, not superficial ones. Further,
the other studies mostly looked at equivalent wounds in equivalent
locations. **Without exception**, gunshot wounds were more serious and
more likely to lead to death. I've appended the abstracts of the studies
from Medline.

> But wait until you penetrate a viscous or ( especially ) cut a great
> vessel. The lesser energy involved in knife wounds is more than
> made up for by their larger size.

This does not seem to be the case. See the attached studies.

As for handgun vs long gun wound mortality, I suggest you look at
table 5.10 of "Point Blank" which presents the results of a
multivariate analysis based on NCS and SHR data and shows no
significant difference.

> Er, this just does not sound right. Long guns ( particularly
> shotguns) are much more destructive than handguns. Compare about
> 200 ft-lbs for 38 Special to 2000 ft lbs for a high-power military
> round.

The kinetic energy of the projectile is obviously not the only thing
that matters.

> One possibility---These figures are for people who actually make it
> to the hospital alive.

No. They are are based on the the NCS (victim survey) for the number
and type of woundings and the FBI's supplementary homicide reports for
the number and type of deaths.

Date: 21-Feb-97
Name: T13752_8Nbgjvm
Database: Medline <1992 to January 1997>

Set   Search                                                       Results
---------------------------------------------------------------------------
001   *wounds, gunshot/                                               1071
002   *wounds, stab/                                                   293
003   1 and 2                                                           52
004   from 3 keep 6,9,11,17,21-22,25,27-30,33-36,43-44,47-48,50-51      21

Authors

Muckart DJ. Meumann C. Botha JB.

Title

The changing pattern of penetrating torso trauma in KwaZulu/Natal--a
clinical and pathological review.

Source

South African Medical Journal. 85(11):1172-4, 1995 Nov.

Abstract

The number of patients who sustained penetrating torso trauma and were
admitted to King Edward VIII Hospital and the surgical intensive care unit
were reviewed over 10- and 5-year periods respectively. For the last 4
months of 1992, a comparison was made between victims of trauma admitted
to hospital and those whose bodies were taken directly to the South
African Police medicolegal laboratories in Gale Street, Durban, where the
majority of medicolegal autopsies in the Durban metropolitan area are
performed. The total number of hospital admissions has not changed during
the last decade, but the aetiology of injury has altered considerably.
Stab wounds have declined by 30% whereas gunshot wounds have increased by
more than 800%. The ratio of stab to gunshot wounds admitted to the
intensive care unit reversed within the 5-year period 1987-1992. Direct
admission to the mortuary was three times as common in cases of gunshot
compared with stab wounds. The hospital mortality rate for gunshot wounds
was 8 times that for stab wounds. The establishment of dedicated trauma
centres is essential for the treatment of these injuries, and strategies
to control the use of firearms are vital.
Authors

Heary RF. Vaccaro AR. Mesa JJ. Balderston RA.

Title

Thoracolumbar infections in penetrating injuries to the spine.

Source

Orthopedic Clinics of North America. 27(1):69-81, 1996 Jan.

Abstract

A detailed review of the TJUH experience and the published literature on
gunshot and stab wounds to the spine has been presented. The following
statements are supported. (1) Military (high-velocity) gunshot wounds are
distinct entities, and the management of these injuries cannot be carried
over to civilian (low-velocity) handgun wounds. (2) Gunshot wounds with a
resultant neurologic deficit are much more common than stab wounds and
carry a worse prognosis. (3) Spinal infections are rare following a
penetrating wound of the spine and a high index of suspicion is needed to
detect them. (4) Extraspinal infections (septic complications) are much
more common than spinal infections following a gunshot or stab wound to
the spine. (5) Steroids are of no use in gunshot wounds to the spine. In
fact, there was an increased incidence of spinal and extraspinal
infections without a difference in neurologic outcome compared with those
who did not receive steroids. (6) Spinal surgery is rarely indicated in
the management of penetrating wounds of the spine. The recommendations for
treatment at TJUH of victims of gunshot or stab wounds with a resultant
neurologic deficit are as follows. (1) Spine surgery is indicated for
progressive neurologic deficits and persistent cerebrospinal fluid leaks
(particularly if meningitis is present), although these situations rarely
occur. (2) Consider spine surgery for incomplete neurologic deficits with
radiographic evidence of neural compression. Particularly in the cauda
equina region, these surgeries may be technically demanding because of
frequent dural violations and nerve root injuries/extrusions. These cases
must be evaluated in an individual case-by-case manner. The neurologic
outcomes of patients with incomplete neurologic deficits at TJUH who
underwent acute spine surgery (usually for neural compression secondary to
a bullet) were worse than the outcomes for the patients who did not have
spine surgery. A selection bias against the patients undergoing spine
surgery was likely present as these patients had evidence of ongoing
neural compression. (3) A high index of suspicion is necessary to detect
spinal and extraspinal infections. (4) Do not use glucorticoid steroids
for gunshot wound victims. (5) Conservative (nonoperative) treatment with
intravenous broad spectrum antibiotics and tetanus prophylaxis is the sole
therapy indicated in the majority of patients who sustain a penetrating
wound to the thoracic or lumbar spines.
Authors

Madiba TE. Mokoena TR.

Title

Favourable prognosis after surgical drainage of gunshot, stab or blunt
trauma of the pancreas [see comments].

Source

British Journal of Surgery. 82(9):1236-9, 1995 Sep.

Abstract

The records of 152 patients with pancreatic injury treated over a 5-year
period were reviewed. The diagnosis was made at laparotomy in all
patients. Gunshot wounds, stab wounds and blunt trauma occurred in 63, 66
and 23 patients respectively with mean ages of 28, 28 and 30 years.
Multiple organ injury was most common after gunshot wounds. Intraoperative
management was by drainage of the pancreatic injury site alone in the
majority of patients in all aetiological groups. The rate of fistula
formation was 14 per cent after gunshot wounds, 9 per cent after stab
injury and 13 per cent after blunt trauma. Death occurred after 24 h in 8,
2 and 10 per cent of patients following gunshot wounds, stab wounds and
blunt trauma respectively, and was attributable to other organ damage. It
is concluded that gunshot injury to the pancreas may be more extensive
than other injuries, but conservative management with surgical drainage of
pancreatic injury is justified irrespective of the mechanism of injury.
Authors

Velmahos GC. Degiannis E. Hart K. Souter I. Saadia R.

Title

Changing profiles in spinal cord injuries and risk factors influencing
recovery after penetrating injuries.

Source

Journal of Trauma. 38(3):334-7, 1995 Mar.

Abstract

OBJECTIVE: The changing profiles of spinal cord injuries in South Africa
are addressed in this study. DESIGN: A retrospective analysis of 551
patients with spinal cord injury. MATERIALS AND METHODS: The cause of
injury was motor vehicle crashes in 30%, stab wounds in 26%, gunshot
wounds in 35%, and miscellaneous causes 9%. MEASUREMENTS AND MAIN RESULTS:
There was a significant shift from stab wounds towards bullet wounds over
the last five years. Bullet spinal cord injuries increased from 30 cases
in 1988 to 55 cases in 1992, while stab spinal cord injuries decreased
from 39 cases in 1988 to 20 cases in 1992. The incidence of spinal cord
injuries following a motor vehicle crash showed a declining tendency after
a transient increase (28 cases in 1988, 40 in 1990, 31 in 1992). Moreover,
the problem of severe septic complications has been investigated and
various risk factors for sepsis that might impair the rehabilitation
process have been examined. The risk of developing septic complications
was higher in gunshot spine injuries (21 cases out of 193) than in knife
injuries (5 cases out of 143). The presence of a retained bullet did not
seem to increase the chances for sepsis. In seven patients the sepsis was
the direct consequence of the retained bullet while in 14 patients sepsis
developed with no bullet in situ. Furthermore, the site of the injury
(cervical, thoracic, lumbar spine) did not correlate with the
abovementioned risks. CONCLUSIONS: Gunshots carry a heavier prognosis.
Only 32% of our gunshot cases underwent a significant recovery as opposed
to 61% of stab cases and 44% of the motor vehicle crash victims.
Authors

Degiannis E. Velmahos GC. Florizoone MG. Levy RD. Ross J. Saadia R.

Title

Penetrating injuries of the popliteal artery: the Baragwanath experience.

Source

Annals of the Royal College of Surgeons of England. 76(5):307-10, 1994
Sep.

Abstract

This study describes the management of 43 patients with penetrating injury
of the popliteal artery. Of these patients, 33 (76.5%) had bullet wounds,
four patients (9.5%) pellet wounds and 6 (14%) knife wounds. Patients with
'hard' signs of arterial injury underwent exploration without preoperative
angiograms. There were no negative explorations. Patients with only 'soft'
signs of arterial injury underwent preoperative angiograms. Of this group,
75% had positive angiograms and underwent exploration. There were no
false-positive or false-negative preoperative angiograms in the group of
patients with 'soft' signs in this study. Definitive orthopaedic
management of associated fractures followed vascular reconstruction. There
was no difference in the short-term patency of autologous saphenous vein
graft as against PTFE grafts. Fasciotomy was performed on patients who had
arterial and venous injury or presented late. Overall amputation rate was
14% and for bullet injuries 18%.
Authors

Rothlin M. Vila A. Trentz O.

Title

[Results of surgery in gunshot and stab injuries of the trunk]. [German]

Source

Helvetica Chirurgica Acta. 60(5):817-22, 1994 Jul.

Abstract

Between 1981 and 1990, 105 patients suffering from gunshot and stab wounds
were admitted to the Department of Surgery of Zurich University Hospital.
There were 17 female and 88 male patients aged 16-74 years (average 31
years) whose charts were studied retrospectively. 44 patients demonstrated
gunshot injuries, while 60 suffered from stabwounds and 1 patient had
both. The injuries were the result of a crime in 59, a suicide in 33 and
an accident in 11 cases. In 2 patients the cause was not conclusive
proven. Injuries to the lung (n = 54), the liver (n = 27) and to the
stomach (n = 23) were seen most frequently. 45 patients underwent
laparotomy, while 16 had a thoracotomy performed. Both thoracotomy and
laparotomy were necessary in 10 cases. Complications were observed in
29.5% of the cases. They were significantly more frequent in patients with
gunshot injuries (p < 0.0004). Overall mortality amounted to 14.3% (n =
15). Patients with gunshot wounds had a significantly higher mortality
rate (p < 0.0005). Debridement and selective closure of the wounds (n =
25) did not result in a higher rate of abscess formation than open
treatment (n = 17).
Authors

Coimbra R. Prado PA. Araujo LH. Candelaria PA. Caffaro RA. Rasslam S.

Title

Factors related to mortality in inferior vena cava injuries. A 5 year
experience.

Source

International Surgery. 79(2):138-41, 1994 Apr-Jun.

Abstract

Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a
5 year period were retrospectively analyzed in order to assess those
factors related to early deaths. Mean age was 32 and 45 were male. GSW was
the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and
blunt trauma (12.2%). There were 4 injuries in the supra diaphragmatic
IVC, 14 retrohepatic, 16 suprarenal and the remaining 15 were in the
infrarenal portion of the IVC. Twenty patients were in shock and 8 were
unstable on admission. The liver was the most frequently injured organ in
association with IVC and there were also 7 concomitant abdominal vascular
injuries. Venorrhaphy was performed in 28 patients, IVC ligature in 5,
intracaval shunt in 3 and in the remaining 13, only temporary hemostasis
was attempted. Mortality rate was 100% in supra diaphragmatic injuries,
71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries.
There was a significant difference when comparing mortality rate in stable
against shock or unstable patients on admission (p < 0.001), as well as in
those with diaphragmatic IVC injuries compared with all other injury sites
together (p < 0.05). Hemodynamic instability on admission was the most
important cause of early deaths, and all patients with concomitant
abdominal vascular injuries also died.
Authors

Degiannis E. Velmahos G. Krawczykowski D. Levy RD. Souter I. Saadia
R.

Title

Penetrating injuries of the subclavian vessels.

Source

British Journal of Surgery. 81(4):524-6, 1994 Apr.

Abstract

A study was made of 76 patients with subclavian vessel injury. The
mechanism of trauma was stabbing in 40 patients (53 per cent) and gunshot
in 36 (47 per cent). There were marked differences between the two groups
in clinical presentation, operative management and outcome. The group with
gunshot injury was characterized by a more immediate threat to life, and a
greater need for a median sternotomy and use of interposition grafts. The
mortality rate in patients with gunshot wounds was more than twice that in
the group with stab injury.
Authors

Tang E. Berne TV.

Title

Intravenous pyelography in penetrating trauma.

Source

American Surgeon. 60(6):384-6, 1994 Jun.

Abstract

Intravenous pyelograms (IVPs) are routinely used in the workup of
suspected urologic injuries. The indications for obtaining IVPs have not
been well characterized. This study examined 67 patients with penetrating
trauma who received formal IVPs with nephrotomography in the radiology
department. Of 35 stab wounds, 19 patients presented without hematuria and
accounted for only one positive IVP. No intervention was undertaken in
this patient. There were 14 stab wound patients with microscopic
hematuria, with three positive IVPs. No intervention was necessary in any
of these patients. The two remaining stab wound patients both had gross
hematuria and renal injuries requiring intervention. However, only one of
the two had a positive IVP, showing a blurred kidney margin. One patient
had a pseudoaneurysm of a branch of the renal artery, and the other had an
arteriovenous fistula. Of 32 patients with gunshot wounds, 15 presented
without hematuria. Of the 15, one had a positive IVP but did not have a
renal injury on exploration. None of the other 13 patients in this group
undergoing exploration had renal injuries. Of the 11 patients with
microscopic hematuria, three had hematomas and one had gross extravasation
on IVP. Of the six patients with gross hematuria, three had positive IVPs,
showing a hematoma, a renal fracture, and indistinct renal outline,
respectively. In this limited study, omitting IVPs on the patients with
negative urinalyses would not have missed any significant injuries. We
suggest that more study is needed in this area because our present
standard may lead to unnecessary expense and delay.
Authors

Velmahos GC. Degiannis E. Souter I. Saadia R.

Title

Penetrating trauma to the heart: a relatively innocent injury.

Source

Surgery. 115(6):694-7, 1994 Jun.

Abstract

BACKGROUND. The purpose of this study was to examine the mortality rate of
penetrating cardiac trauma in a large urban hospital. METHODS. This was a
retrospective study over a period of 5 years and 5 months of all patients
admitted alive with a stab or a gunshot cardiac injury. RESULTS. There
were 310 patients with a stab wound and 63 with a gunshot wound. The
overall mortality rate was 19%. The mortality rates for the stab and the
gunshot groups were 13% and 50.7%, respectively. In the 296 patients with
a cardiac stab wound confined to a single chamber and with no other
associated extracardiac injury the mortality rate was 8.5%. CONCLUSIONS.
An isolated cardiac stab wound is a relatively innocent injury in a
patient at a hospital accustomed to managing penetrating trauma
expeditiously.
Authors

Mock C. Pilcher S. Maier R.

Title

Comparison of the costs of acute treatment for gunshot and stab wounds:
further evidence of the need for firearms control [see comments].

Source

Journal of Trauma. 36(4):516-21; discussion 521-2, 1994 Apr.

Abstract

Gun control is proposed primarily to decrease the incidence of injury and
death from gunshot wounds (GSWs). We hypothesize that decreasing the
number of GSWs will also produce significant economic savings, even if
personal violence were to continue at the same rate, maintaining the same
overall incidence of penetrating trauma. We analyzed charges and
reimbursements for the treatment for all patients with GSWs (n = 1116) and
stab wounds (SWs) (n = 1529) admitted to a level I trauma center from 1986
through 1992. Mean and median charges were higher for GSWs ($14,541;
$7,541) than for SWs ($6,446; $4,249) (p < 0.05). There was a 12% per year
increase in the annual number of GSWs (p = 0.001), leading to a
disproportionate increase in the annual total charges for GSWs (p =
0.013), compared with SWs. Public expenditures, including bad debt and
government reimbursement, increased for GSWs (p = 0.019) but not SWs.
Thus, if all patients with GSWs instead suffered SWs, there would be an
annual savings of $1,290,000 overall and of $981,000 of public funds from
this institution alone. Treatment costs for GSWs are higher than those for
SWs and are rising more rapidly, with an increasing amount of public funds
going to meet these costs. Considerable savings to society would accrue
from any effort that decreased firearm injuries, even if the same level of
violence persisted using other weapons.
Authors

Rizoli SB. Mantovani M. Baccarin V. Vieira RW.

Title

Penetrating heart wounds.

Source

International Surgery. 78(3):229-30, 1993 Jul-Sep.

Abstract

In 3 years, 26 patients were operated for penetrating heart wounds at our
institution, the majority between 30 to 60 minutes after injury.
Twenty-two patients with a possible heart wound were immediately taken to
the operating room for thoracotomy. One patient initially underwent
laparotomy while 2 were observed before operating-room thoracotomy. One
patient underwent emergency-room thoracotomy. Three patients with no vital
signs on admission died, 82.6% of the remainder survived. Stab wounds
determined the best survival rate: 94%, whereas for gunshot wounds it was
only 50%. Our experience at this Brazilian Trauma Center reveals that
delay in reaching the hospital selected the patients, that clinical
condition on arrival, method of injury (knife or gunshot), emergency room
staffed with trauma surgeons and aggressive operating room treatment for
penetrating heart wounds results in a remarkable survival rate.
Emergency-room thoracotomy should be reserved for patients "in extremis"
or when there is no operating room available.
Authors

Macho JR. Markison RE. Schecter WP.

Title

Cardiac stapling in the management of penetrating injuries of the heart:
rapid control of hemorrhage and decreased risk of personal contamination.

Source

Journal of Trauma. 34(5):711-5; discussion 715-6, 1993 May.

Abstract

The resuscitation of patients with cardiopulmonary arrest from a
penetrating injury of the heart requires emergency thoracotomy and control
of hemorrhage. Suture control may be technically difficult in patients
with large or multiple lacerations. Emergency cardiac suturing techniques
expose the surgeon to the risk of a contaminated needle stick. After we
determined that rapid control of hemorrhage from cardiac lacerations could
be achieved in anesthetized sheep with the use of a standard skin stapler,
the technique was applied in the clinical setting. Twenty-eight patients
underwent emergency stapling of 33 cardiac lacerations at our institution
from September 1987 to December 1991. Seventy-nine percent (22) of the
patients sustained stab wounds, and 21% (6) were injured by gunshots.
Fifty-eight percent (19) of the injuries involved the right ventricle, 27%
(9) involved the left ventricle, 9% (3) involved the right atrium, and 6%
(2) involved the left atrium. In 93% (26) of the patients, control of
hemorrhage was achieved within 2 minutes of exposure of the injuries. Both
patients in whom control could not be achieved had sustained large-caliber
gunshot injuries. Fifteen (54%) of the patients survived, including one
patient with two cardiac lacerations and another with three lacerations.
Of the surviving patients, two had mild neurologic deficits. No personal
contamination occurred related to the use of the stapler. We conclude (1)
cardiac stapling is highly effective in the management of hemorrhage from
penetrating injury, particularly in the setting of multiple cardiac
lacerations; (2) the technique may not be effective with certain types of
gunshot wounds; and (3) the use of the stapler for emergency cardiorrhaphy
eliminates the risk of personal contamination from a needle stick.
[Full paper reveals survival rate of 17% for gunshot wounds and 64%
for stab wounds. TL]
Authors

Mitchell ME. Muakkassa FF. Poole GV. Rhodes RS. Griswold JA.

Title

Surgical approach of choice for penetrating cardiac wounds.

Source

Journal of Trauma. 34(1):17-20, 1993 Jan.

Abstract

One hundred nineteen patients suffered penetrating cardiac trauma over a
15-year period: 59 had gunshot wounds, 49 had stab wounds, and 11 had
shotgun wounds. The overall survival rate was 58%. The most commonly
injured structures were the ventricles. Twenty-seven patients had injuries
to more than one cardiac chamber. Thirty patients had associated pulmonary
injuries. Emergency thoracotomy was performed in 47 patients with 15%
survival. Median sternotomy was used in 30 patients with 90% survival.
Seventeen of the 83 patients with thoracotomies required extension across
the sternum for improved cardiac exposure or access to the contralateral
hemithorax. Only one patient with sternotomy also required a thoracotomy.
All pulmonary injuries were easily managed when sternotomy was used. We
conclude that sternotomy provides superior exposure for cardiac repair in
patients with penetrating anterior chest trauma. We feel it is the
incision of choice in hemodynamically stable patients. Thoracotomy should
be reserved for unstable patients requiring aortic cross-clamping, or when
posterior mediastinal injury is highly suspected.
[Full paper reveals survival rates of 46% for gunshot wounds, 78% for
stab wounds, and 36% for shotgun wounds. TL]
Authors

Kaufman JA. Parker JE. Gillespie DL. Greenfield AJ. Woodson J.
Menzoian JO.

Title

Arteriography for proximity of injury in penetrating extremity trauma.

Source

Journal of Vascular & Interventional Radiology. 3(4):719-23, 1992 Nov.

Abstract

Arteriography for proximity of injury was studied prospectively at a
trauma center. Findings in 85 patients with penetrating extremity wounds
were analyzed to determine the prevalence and types of vascular
abnormalities seen with these injuries. Ninety-two limb segments were
studied for 77 gunshot and 15 stab wounds. Arteriographic findings were
positive in 24% overall but in only 5% for injuries confined to major
vessels. A 60% positive rate was seen in a small subgroup of 10 patients
with fractures due to gunshot wounds. The most frequently injured vessels
were muscular branches of the deep femoral artery (59%); the most common
injury was focal, non-occlusive spasm (42%). All patients were treated
conservatively, without sequelae at follow-up. In this study, the vascular
injuries found at arteriography for proximity of injury in penetrating
trauma due to bullets of knives, particularly in the thigh, did not
require surgical or radiologic intervention.
Authors

Nagel M. Kopp H. Hagmuller E. Saeger HD.

Title

[Gunshot and stab injuries of the abdomen]. [German]

Source

Zentralblatt fur Chirurgie. 117(8):453-9, 1992.

Abstract

From 1973 to 1991 a total of 422 patients underwent surgery because of an
abdominal trauma. 12 patients had gunshot wounds and 46 patients stab
wounds. In a retrospective study the diagnostic and therapeutic procedure
and the indication for surgery are analysed. After gunshot wounds of the
abdomen we always performed a laparotomy. In 11 od 12 cases we found
serious intra-abdominal injuries. Only in one case the laparotomy was
"unnecessary", because of a tangential wound without penetrating of the
abdominal wall. After stab wounds the diagnostic and therapeutic
management was more selective. Indications for mandatory laparotomy after
stab wounds were a manifest hemorrhagic shock, evisceration and a still
left weapon in the abdomen (n = 22). The first clinical examination was
completed by ultrasound or peritoneal lavage. Pathological findings like
free intraperitoneal fluid or a positive lavage also were indications for
laparotomy (n = 9). The other patients were observed closely, including
repeated physical examination. The indication for surgery then based on
the development of clinical signs. The time between first examination and
laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries
of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy.
The mortality rate was 3.4%, but there was no death as a result of the
selective approach.
Authors

Saltzman LE. Mercy JA. O'Carroll PW. Rosenberg ML. Rhodes PH.

Title

Weapon involvement and injury outcomes in family and intimate assaults.

Source

JAMA. 267(22):3043-7, 1992 Jun 10.

Abstract

OBJECTIVE--To compare the risk of death and the risk of nonfatal injury
during firearm-associated family and intimate assaults (FIAs) with the
risks during non-firearm-associated FIAs. DESIGN--Records review of police
incident reports of FIAs that occurred in 1984. Victim outcomes (death,
nonfatal injury, no injury) and weapon involvement were examined for
incidents involving only one perpetrator. SETTING--City of Atlanta, Ga,
within Fulton County. PARTICIPANTS--Stratified sample (n = 142) of victims
of nonfatal FIAs, drawn from seven nonfatal crime categories, plus all
fatal victims (n = 23) of FIAs. MAIN OUTCOME MEASURES--Risk of death (vs
nonfatal injury or no injury) during FIAs involving firearms, relative to
other types of weapons; risk of nonfatal injury (vs all other outcomes,
including death) during FIAs involving firearms, relative to other types
of weapons. RESULTS--Firearm-associated FIAs were 3.0 times (95%
confidence interval, 0.9 to 10.0) more likely to result in death than FIAs
involving knives or other cutting instruments and 23.4 times (95%
confidence interval, 7.0 to 78.6) more likely to result in death than FIAs
involving other weapons or bodily force. Overall, firearm-associated FIAs
were 12.0 times (95% confidence interval, 4.6 to 31.5) more likely to
result in death than non-firearm-associated FIAs. CONCLUSIONS--Strategies
for limiting the number of deaths and injuries resulting from FIAs include
reducing the access of potential FIA assailants to firearms, modifying
firearm lethality through redesign, and establishing programs for primary
prevention of violence among intimates.
Authors

Mercer DW. Buckman RF Jr. Sood R. Kerr TM. Gelman J.

Title

Anatomic considerations in penetrating gluteal wounds.

Source

Archives of Surgery. 127(4):407-10, 1992 Apr.

Abstract

A retrospective study of 81 patients with penetrating gluteal wounds was
performed to determine if the site of penetration was useful in predicting
the likelihood of associated vascular or visceral injury. There were 53
gunshot wounds and 28 stab wounds, including one impalement. The gluteal
region was divided into upper and lower zones by determining whether entry
occurred above or below the greater trochanters. Sixty-six percent of all
penetrating gluteal wounds entered the upper zone. Thirty-two percent of
patients with upper zone penetration had associated vascular or visceral
injury. Only one of 27 patients with lower zone penetration sustained
major injury. The site of entry plays a critical role in determining the
likelihood of serious injury associated with penetrating gluteal wounds.
Wounds penetrating above the greater trochanters demand thorough
evaluation, especially gunshot wounds.

tlambert Sun, 02/23/1997 - 19:26

Tags

knives

Death rate from gun assaults vs death rate from knife assaults

tlambert — Fri, 27 Sep 1996 10:06:55 +0000

Death rate from gun assaults vs death rate from knife assaults

In Point Blank Gary Kleck writes:

The aggressor's possession of a handgun in a violent incident
apparently exerts a very slight net positive effect on the
likelihood of the victim's death. The linear probability
interpretation of the OLS coefficient implies that the presence of a
handgun increases the probability of the victim's death by 1.4%.
thus the violence-increasing and violence-suppressing effects of
gun possession and use almost exactly cancel each other out. This
small association is statistically significant, however, because of
the very large (n=14,922) sample size.

the effects of aggressor weaponry are quite substantial when taken
stage by stage, i.e., when separately examining attack, injury, and
death. This is why impressive-appearing results can be obtained
when researchers examine, for example, only the last stage, looking
solely at the impact of guns on the likelihood of the victim's
death, among those wounded...

The findings also imply that if gun possession were reduced among
aggressors in violent situations, total assault injuries would
increase, the fraction of injuries resulting in death would
decrease, and the total number of homicides would remain about the
same....

This is perhaps the most bone-headed claim Kleck makes in his book.
Kleck's data implies that a 10% reduction
in gun possession by aggressors would result in a 2% decrease in
injuries and a 6% decrease in homicides. This is definitely not
"remain about the same."

tlambert Fri, 09/27/1996 - 06:06

Tags

knives

Are stab wounds as dangerous as gun shot wounds?

tlambert — Sun, 09 Oct 1994 11:57:20 +0000

Are stab wounds as dangerous as gun shot wounds?

Orion writes:

Statscan tells us that of all violent assaults that are not
immediately fatal your odds of survival are better if you are shot rather
than stabbed (some people aren't even immediately aware that they have
been shot!). Knife wounds tend to be large, ugly and tough to repair ass
opposed to neat little bullet entry wounds, depending on location,
calibre and other factors..

Perhaps you could tell us more about what your source says and how it
came to that conclusion.

I looked in Medline for studies on gun shot and stab wound mortality
and it turned up dozens. There was a consistent pattern across
different countries and wound locations --- gunshot wounds were far
more lethal. For example a study in The Journal of Trauma (36:4
pp516-524) looked at all injury admissions to a Seattle hospital over
a six year period. The mortality rate for gunshot wounds was 22%
while that for stab wounds was 4%. Even among patients that survived,
gunshot wounds were more serious --- the mean cost of treatment for
these patients was more than twice that for stab wounds.

Repairing a large entry wound (like from a knife) or a small entry
wound (like from a bullet) is not very difficult in either case. What
is difficult is repairing vital organs. Large low-velocity things
like knives tend to push them out the way, while small high-velocity
things like bullets plow right into them.

tlambert Sun, 10/09/1994 - 07:57

Tags

knives

Are stab wounds as dangerous as gun shot wounds?

tlambert — Sat, 05 Feb 1994 06:09:47 +0000

Are stab wounds as dangerous as gun shot wounds?

Michael J. Phelps writes:

Wright (1983) compare handgun attacks with long bladed knife attacks;
as do Wilson & Sherman (1961 p 643) with findings of:
mortality rate for handguns: 16.8%
                  ice picks: 14.3
             butcher knives: 13.3

Kleck has made a dishonest selection of data from Wilson & Sherman:
from the same table that the figures above were plucked from:

                       rifles: 7.7

Unless you think that handguns are twice as deadly as rifles, this should be a clue that something is very wrong. (Another clue, free of charge: 2/15=13.3% and 2/14=14.3%)

[note that these rates don't address untreated woundings, so the 16%
handgun mortality rate correlates well with Cook's 15%]

They also don't address untreated DEATHs, so the comparison is bogus.

tlambert Sat, 02/05/1994 - 01:09

Tags

knives

Are with-knife assaults as dangerous as with-gun assaults?

tlambert — Sat, 18 Dec 1993 04:40:31 +0000

Are with-knife assaults as dangerous as with-gun assaults?

(C. D. Tavares) writes:

Report to the Nation on Crime and Justice, Second Edition, U.S.
Department of Justice, Bureau of Justice Statistics, NCJ-105506,
March 1988.

For 1985, for robbery and assaults, the following is how
many incidents involved a firearm and how many involved a knife.
          Robbery  Assault
          -------  -------
Firearm   23%      12%
Knife     21%      10%
In both robbery and assault, a gun was actually fired and hit the victim
only 4% of the time in all incidents in 1985. Victims were actually
stabbed in 10% in the incidents involving knives.

Gun and knife robberies are equally like to result in serious injury.
The fatality rate in gun robberies is three times that of knife
robberies.
(Cook, J of Criminal Law and Criminology 78:357-76)

In Point Blank, by Gary Kleck, pg 165:

(He cites a study by Wilson and Sherman, 1961)

"At least one medical study compared very similar sets of wounds ('all were
penetrating wounds of the abdomen'), and found that the mortality rate in
pistol wounds was 16.8%, while the rate was 14.3% for ice pick wounds and
13.3% for butcher knife wounds.

Kleck is misrepresenting this study. Those are mortality rates of
patients who survive long enough to reach the hospital alive. From
that same paper: "...the preponderance of stab wounds is more apparent
than real because a significant percentage of patients wounded by
gunshot die before reaching hospital." In any case, the percentages
quoted to three significant figures above are based on such small
numbers as to be meaningless (e.g. 14.3%=2/14, and 13.3%=2/15).

A single knife wound is roughly equivalent to a single .38 gunshot wound.

I think you just made this up, cdt. What evidence do you have for
this claim?

The problem here is that a knife attack usually involves more than a
single strike.

And what evidence do you have for this? Perhaps you would care to
tell us how the fatality rate for knife assaults compares with that
for gun assaults?

tlambert Fri, 12/17/1993 - 23:40

Tags

knives

Are stab wounds as dangerous as gun shot wounds?

tlambert — Tue, 05 Oct 1993 11:52:48 +0000

Are stab wounds as dangerous as gun shot wounds?

Point Blank, by Gary Kleck, pg 165, citing a study by Wilson and Sherman, 1961:

"At least one medical study compared very similar sets of wounds ('all were
penetrating wounds of the abdomen'), and found that the mortality rate in
pistol wounds was 16.8%, while the rate was 14.3% for ice pick wounds and
13.3% for butcher knife wounds.

The study is in Annals of Surgery Vol 153 pp 639-649 "Civilian
Penetrating Wounds of the Abdomen" by Wilson and Sherman. It covers stab
(5% mortality) and gun shot wounds (17% mortality) to the abdomen.

The numbers Kleck quotes above come from Table 7 of the article which
contains mortality data by weapon. The implication seems to be that
"knives are almost as deadly as guns". This is extremely misleading.

There are two basic questions to be answered:

Exactly what was measured?
Is the result statistically significant?

(1) The data is from 452 admissions with abdominal wounds to a
hospital in Memphis, Tennessee over the period 1948-1959.

(1a) People who died before reaching hospital are NOT counted. In the
discussion following the paper it is stated that "the preponderance of
stab wounds is more apparent than real because a significant
percentage of patients wounded by gunshot die before reaching the
hospital.", so this will make the mortality rate for gunshot wounds
appear to be less.

(1b) The wounds include self-inflicted and accidental cases. Someone
attempting suicide with a gun will probably aim at the head, but a
a would-be knife suicide may well attempt disembowelment.

(1c) Mortality rates for wounds to other parts of the body may well be
very different. For example, a low velocity weapon like a knife is
far less likely to penetrate a skull than a high velocity projectile.

(1d) The distribution of wounds is different for knife assaults and
gun assaults, since victims of knife assaults have more chance to
dodge and block.

(1e) Medical treatment has improved since 1948. More recent results
on abdominal wound mortality (Annals of Surgery 179 pp 639) show that
stab wounds are 1% lethal and gun shot wounds are 13% lethal.

(1f) The weapon used was known for only some of the cases. The
mortality rate for gunshot wounds where the type of gun was unknown
was 29%, so this made the mortalities for each type of gun appear to
be lower than they really were.

(2) The 13.3% death rate for butcher knife wounds is based on a mere 15
cases. This is far too few to give a meaningful mortality rate. The
death rate for rifle wounds was 7.7% (based on only 26 cases). Do
you think rifles are half as lethal as handguns?

I have calculated 95% confidence intervals for each of the weapons in
the paper. Here are the results:

Weapon     Cases    Deaths   % Deaths    95% conf for mortality rate
Shotgun       49        10       20.4    11%-34%
Pistol       101        17       16.8    11%-25%
Ice Pick      14         2       14.3    4%-40%
Butcher Knife 15         2       13.3    4%-38%
Rifle         26         2        7.7    2%-24%
Switch-blade
knife         17         1        5.9    1%-27%
Pocket knife  44         0          0    0%-8%
Unknown GSW   14         4       28.6    12%-55%
Other stab   172         9        5.2    3%-10%

All GSW      190        33       17.4    13%-23%
All stab     262        14        5.3    3%-9%

We see that mortalities for each pointed weapon are not significantly
different from mortalities for all pointed weapons, but that
mortalities for stab wounds are significantly less than mortalities from gun
shots.

95% confidence intervals for mortalities calculated from (Annals of
Surgery 179 pp 639) are 1%-2% for abdominal stab wounds, and 11%-15%
for abdominal gun shot wounds.

tlambert Tue, 10/05/1993 - 07:52

Tags

knives

thanks for the statistics. when i go to battle over there i won't be so concerned about getting shot

Handgun wounds are not as bad as knife wounds. Bullet wounds, however, are worse. (haha)

Are with-knife assaults as dangerous as with-gun assaults?

tlambert — Tue, 31 Mar 1992 20:34:02 +0000

Are with-knife assaults as dangerous as with-gun assaults?

With-gun robberies are three times as likely as with-knife
robberies to be fatal to the victim[1], and it seems plausible that
this lethality extends to other crimes.

Andy Freeman said:

No, with-gun robberies are not three times as likely as with-knife
robberies to be fatal to the victim. Lambert consistently
"misreports" Zimring's data.

It is Andy who consistently and wilfully "misreports" Zimring's data.
Interested readers can look at his November Scientific American
article, his book "Citizen's Guide to Gun Control", or the original
journal article (J of Legal Studies 15 (1986):1,16).

A quote from his book: "The death rate from gun robberies is at least
three times as high as the death rate from knife robberies"

And an extract from a table in the book

Percentage Distribution of Robberies and and Robbery Killings by
Location & Weapon
         Commercial          Street              Other
         Robberies           Robberies           Robberies
         Kill-  Non-         Kill-  Non-         Kill-  Non-
         ings   Lethal       ings   Lethal       ings   Lethal
Gun      81     67           67     39           83     43
Knife    13     11           11     15           13     15

Lambert doesn't like trend analysis;
look at his statistical arguments for the effects of gun control in
Oz and the UK. his stats and analysis are completely consistent
with "the crime rate was decreasing before gun control, but its
introduction stopped that decrease", which fits the data better than
his model.)

Andy has asserted this before, but has never provided arguments or
analysis to support it. He has not because he cannot. No matter how
many times he asserts it, it will continue to be false. A model was
proposed where there was a decline that ended some years after control
--- this was twice as complicated and fit worse than the "constant rate
before, constant rate after" model.

Heck; he doesn't even bother to control for other factors. He
just asserts that they have no effect,

Perhaps you will show me where I have ever made such as assertion.
Just because you're into "proof by assertion" doesn't mean other
people are.

even though crime rates change greatly even when gun control
doesn't. (Look at the changes in the US murder rate from the 1900s
through the 1990s for many examples, and notice that the low point
corresponds to the least gun control....)

It would be more relevant to look at the NSW homicide rate. After
1920, the rate has been essentially constant, in spite of the
Depression, WW2, a five-fold increase in population, massive
immigration, a doubling of urbanisation, large demographic changes,
and major social change.

It is also interesting to note that the US non-gun homicide rate has
also changed little over that period, so that whatever caused the
change in the overall homicide rate is somehow connected with guns.

tlambert Tue, 03/31/1992 - 15:34

Tags

knives