Mortality Rate Of Stab Wounds: How Many People Survive Penetrating Trauma?

As we know, between the time the 911 call was placed (12:18 pm) and the time of his death (1:36 pm), an unconscious Elliott Smith managed to survive for more than 1 hour. if we don’t know exactly when the stabbing occurred, I have always wondered about data regarding the number of people who survive trauma and especially penetrating trauma.

This extensive 2019 study, published in JAMA Surgery, which focused on patients with stab wounds in the torso and survival rate, compared the mortality rates when they were treated at level I trauma centers and level II centers. It included a total of 17,245 patients with torso wounds, between January 2010 and January 2016. Unsurprisingly, they found that patients treated at level I had a lower risk of mortality than patients treated at level II, but the surprise came from their numbers for mortality rates. The percentage of people who died after receiving a thoracotomy (what was done to Elliott in an attempt to repair his heart) was relatively low: 24.3% for level I and 34.1% for level II. Meaning that, respectively, 3/4 and 2/3 of people survived thorax stab wounds. I didn’t expect these numbers.

Another extensive study, done in Philadelphia between 2003 and  2007 and published in the Annals of Emergency Medicine, confirmed these results. It included a very large number of patients (4,122) suffering from penetrating trauma injuries (either gunshot or stabbing). If the study focused on the differences in mortality rate when patients are transported by the police department or by EMS, the same low number was found for the overall mortality rate: 27.4 %.

This other study, about stabbing incidents at Folsom Prison in 1989, revealed an even lower mortality rate: only 3%, maybe because patients were treated right away? This other 1989 study, done at King-Drew Medical Center in Los Angeles, revealed that the mortality rate of stabs in the heart was only 11.5%: out of 52 people with stab wounds penetrating the heart, only 6 died when treated at the hospital, where a thoracotomy was performed.

What does it mean for Elliott? That his case is obviously in the very unlucky category and falls in the minority of cases.

We have to keep in mind that all these studies only considered homicides since suicides by stabbing are so rare. Nevertheless, this 2014 study compared self-inflicted stab wounds and assault-induced stab wounds and clearly stated that ‘most self-inflicted stab wounds are non-lethal abdominal and retroperitoneal injuries.’ The purpose of the study was to assess the mortality and morbidity of self-inflicted stab wounds versus assault-induced stab wounds, and they found an overall mortality rate for assault-induced stab wounds of 27.3%, whereas this same mortality rate was equal to zero for self-inflicted stab wounds. The authors explained this difference by the greater numbers of wounds and organs injured in case of assault-induced stab wounds, but also by the greater velocity of stabbing in this case. They also commented that a significant proportion of suicides by self-stabbing are ‘the result of impulsive actions, and there is often no mortality in such cases.’ In 50% of the self-inflicted cases, patients were drunk, and if psychosis was also strongly associated with such self-harm, the three patients with psychotic illness in the study ‘experienced mortality and morbidity no different from other self-inflicted stab wounds patients.’ The authors even mentioned ‘harakiri wound, a transverse cut of the abdomen and a traditional method of suicide in Japan,’ and a major cause of death, but since harakiri deaths are exclusive to Japan, it’s irrelevant elsewhere. Despite the fact that this was a relatively small study, it’s also interesting to note that zero chest wounds were found in the self-inflicted stab wounds group. As we know Elliott had two deep stab wounds in the chest.

What can we conclude from all this? Once again, these studies emphasize the oddity of Elliott’s case, as the large majority of people with stab wounds survive. And the mortality rate is even lower (null in the above study) if stab wounds are self-inflicted. In Elliott’s case, his death should have been found even more abnormal, since someone was present in the same room. But as we already know, Jennifer Chiba probably didn’t assist him right away. I cannot stress this enough.