A Multidisciplinary Evaluation of Sharp-Force Injuries: Clinical, Physiological, and Forensic Perspectives from a Tertiary Care Surgical Unit

Abstract

Background: Sharp-force injuries are clinically heterogeneous and may combine major anatomical damage, physiological instability, and medicolegal complexity.

Objective: To evaluate the clinical, physiological, and forensic characteristics of sharp-force injuries and identify factors associated with adverse outcomes.

Methods: This prospective multicenter observational study included 120 adults presenting with acute sharp-force injuries to Amna Inayat Medical College, Sheikhupura, and Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan, from January to September 2025. Clinical variables, anatomical injury patterns, shock index, serum lactate, hemoglobin, Injury Severity Score, wound morphology, defense-type injuries, management, and in-hospital outcomes were recorded.
Results: Mean age was 32.4 ± 11.2 years; 81.7% were male. Interpersonal assault accounted for 68.3% of cases, and stab wounds for 72.5%. Major visceral or vascular injury occurred in 40.8%, while 52.5% required operative intervention, 18.3% required intensive care, and mortality was 5.0%. Adverse outcomes occurred in 37.5% of patients. Shock index >0.9, serum lactate >2 mmol/L, Injury Severity Score ≥16, and major visceral or vascular injury were independently associated with adverse outcomes. Defense-type injuries were more frequent in assault-related cases but did not independently predict clinical deterioration. Thoracoabdominal injuries carried the greatest burden of internal damage and operative management, underscoring the importance of assessment.

Conclusion: Sharp-force trauma requires integrated clinical, physiological, and forensic assessment. Early physiological compromise and anatomical severity were the strongest determinants of adverse outcome, while forensic wound patterns provided complementary medicolegal context.