Epidemiological characteristics and predictors of surgical intervention in forensic sharp and penetrating injuries

Abstract

Objective: This study aimed to analyze the epidemiological and clinical characteristics of forensic sharp and penetrating injuries and to identify independent predictors of surgical intervention in a tertiary trauma center. Patients and Methods: This retrospective cohort study included all patients presenting with forensic-reported sharp and penetrating injuries to a level 1 trauma center between January 1 and December 31, 2024. Demographic characteristics, injury mechanisms, anatomical injury locations, vital signs, imaging use, and clinical outcomes were extracted from electronic health records. The primary outcome was the need for surgical intervention. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of surgery. Results: A total of 1,076 patients were included, of whom 123 (11.4%) required surgical intervention. The cohort was predominantly male (85.8%) with a median age of 30 years. Upper extremity trauma was the most common anatomical site (73.8%), particularly in self-inflicted cases. Hemodynamic instability at presentation was strongly associated with surgery (OR 10.70). Increasing age was independently associated with surgical intervention, with each additional year increasing the odds by approximately 3%. Male sex (OR 3.45) and foreign nationality (OR 3.69) were also independent predictors. Injuries involving the head, maxillofacial, or neck region were associated with a lower likelihood of surgical management (OR 0.18). Conclusion: In this large, single-center cohort of forensic sharp and penetrating injuries, older age, male sex, foreign nationality, and hemodynamic instability at presentation emerged as key early predictors of surgical intervention, while head, maxillofacial, and neck injuries were less likely to require operative management. These findings underscore the value of early clinical assessment and regionspecific trauma data in supporting timely surgical decision-making, injury-prevention strategies, and local trauma system planning.

Keywords

• Sharp trauma
• Penetrating injury
• Surgical intervention
• Predictors
• Forensic cases

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