Undeclared civil war? Urban violence in major city in Brazil

ABSTRACT Purpose: Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. Methods: Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. Results: Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). Conclusions: Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.

摘要
目的：全球范围内，2.5%的死亡病例由民间暴力所致；21世纪以来，民间暴力致死的总人数超过了所有战争的阵亡总和。本研究针对巴西萨尔瓦多某创伤转诊医院收治的暴力受害者展开描述，并分析不同类型人际暴力的影响。
方法：本研究纳入2015年7月至2017年7月期间收治的人际暴力受害者。共计1296例患者（平均年龄30.3岁；男性占比90%），根据人际暴力的致伤机制分为3组：1）殴打致伤；2）火器伤；3）刺伤（stab wound, STW）。对各组的以下变量进行比较：年龄、性别、创伤致伤机制、入院时修正创伤评分（Revised Trauma Score, RTS）、重症监护病房（intensive care unit, ICU）救治需求、住院时长、血液制品输注需求及死亡结局。
结果：火器伤（gunshot wounds, GSW）是最主要的致伤机制（59%），其次为殴打致伤（24%）与刺伤（17%）。火器伤受害者入院时的平均修正创伤评分更低，对血液制品输注的需求更高，且重症监护病房收治率更高。殴打致伤受害者的平均住院时长最长（11.6 ± 19.6天）。火器伤组的死亡病例占总死亡人数的77.4%。火器伤组的院内死亡率（12.7%）显著高于殴打组（5.4%）与刺伤组（4.9%）。
结论：研究结果显示，火器伤受害者的病情更为危重：与刺伤及殴打致伤受害者相比，其需要更长时间的重症监护病房支持、更多的血液制品输注，且死亡率更高。