Use of a national trauma registry to target violence reduction initiatives


      • Penetrating trauma has increased in the UK.
      • Violence reduction initiatives are increasingly used to target penetrating trauma.
      • Key demographic information about who is involved, where and when, can help to target violence reduction initiatives.
      • This study demonstrated that the use of a national trauma registry can provide key information with which to target VR initiatives.



      The incidence of interpersonal violence resulting in penetrating traumatic injury has increased in the UK. Violence reduction initiatives vary across the world, from reactive diversionary schemes to proactive educational intervention. To be successful a collaborative public health approach to violence reduction is vital. We examined regional data collected in a trauma network area as part of mandatory national trauma data submission to establish whether useful data could be extracted from this type of registry to inform regional violence reduction initiatives. Key information required to accurately target initiatives includes: who are the victims? where do incidents occur? and when do incidents occur?


      Data were obtained from the national Trauma Audit and Research Network (TARN). This study utilised TARN inclusion criteria. Data for penetrating trauma patients from hospital sites in the Severn Major Trauma Network over an eight-year period were included in the analysis (1 June 2012 to 5 April 2020). The data were analysed using SPSS Statistics V27 and TARN analytics software. Existing ethical approval for anonymised registry data (PIAG section 60) was used.


      Over the eight-year study period, 299 cases of penetrating trauma were registered in the Major Trauma Network. Overall, the incidence of penetrating trauma is increasing (R value +0.470, and +0.900 when 2020 excluded). Male victims account for 87.3% of cases (n=261). Younger individuals are more likely to be victims of penetrating trauma. The proportion of victims aged 13-18 years increased from 0% in 2012 to 21.6% in 2019. There were 43 (14.3%) incidents of victims presenting more than once during the study period. The early evening and hour after midnight had the highest numbers of penetrating trauma incidents. Most incidents occurred in a small proportion of postcodes. All the postcodes identified as having high incidence of penetrating injuries were also areas with high deprivation.


      This study demonstrated that national trauma registry data can be used to establish valuable information about serious penetrating trauma in a region. This data provides key information with which to target a proactive approach to violence reduction in our region with implications for public health, police, and clinical policymakers.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. UNODC. Global study on homicide 2019 [Internet] Vienna; 2019. [Cited 14 Jan 2022]. Available from:

        • GBD 2017 Causes of Death Collaborators
        Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the global burden of disease study 2017.
        Lancet. 2018; 392: 1736-1788
      2. Krug E, Dahlberg L, Mercy J, Zwi A and Lozano R. World report on violence and health [Internet] Geneva; 2002 [Cited 14 Jan 2022]. Available from:

        • Mercy J
        • Hillis S
        • Butchart A
        • Bellis M
        • Ward C.
        • Fang X
        • Mock C
        • Nugent R
        • Kobusingye O
        • Smith K
        • et al.
        Chapter 5: interpersonal violence: global impact and paths to prevention.
        (editors)Injury Prevention and Environmental Health. 3rd Ed. World Bank, Washington, DC2017
        • Soreide K.
        Epidemiology of major trauma.
        Br J Surg. 2009; 96: 697-698
      3. Greater London Authority. A report on the London Violence Reduction Unit produced for the Home Office. [Internet] March 2021. [Cited 5 Jun 2021]. Available from:

      4. Commons Library. Knife crime in England and Wales. [Internet] Sept 2021. [Cited 5 Jun 2022]. Available from:

      5. Home Office. Police recorded crime and outcomes open data tables. [Internet] United Kingdom; 2021. [Cited 14 Jan 2022]. Available from:

      6. Office for National Statistics. Crime in England and Wales: year ending December 2019. [Internet] 2020. [Cited 14 Jan 2022]. Available from:∼:text=Figures%20for%20the%20year%20ending,and%20the%20highest%20on%20record

      7. Economic and Social Research Council. Millennium Cohort Study [Internet] 2017. [Cited 14 Jan 2022] Available from:

      8. Office for National Statistics. Crime in England and Wales: year ending September 2020. [Internet] 2020. [Cited 14 Jan 2022] Available from:

      9. World Health Organisation. Violence prevention through multisectoral collaboration. [Internet] New York; 2021. [Cited 14 Jan 2022] Available from:

        • Shepherd J.
        Violence as a public health problem. Combined approach is needed.
        BMJ. 2003; 326: 104
        • Heath I.
        Treating violence as a public health problem.
        BMJ. 2002; 325: 726-727
      10. TARN. Inclusion Criteria The Trauma Audit & Research Network (TARN). [Internet] 2020. [Cited 14 Jan 2022] Available from:

      11. TARN. TARN analytics user guide. [Internet] Salford; Oct 2020 [Cited 14 Jan 2022] Available from:

      12. Office for National Statistics. Populations by index of multiple deprivation (IMD) decile, England and Wales, 2020. [Internet] 2021 [Cited 14 Jan 2022]. Available at:

      13. Ministry of Housing. English indices of deprivation 2019 [Internet]. 2019 [cited 14 Jan 2022] Available from:

      14. Jacobs, N. Health services and police use workshop to highlight risk of violence [Internet] 2021. [Cited 14 Jan 2022] Available at:

        • Florence C
        • Shepherd J
        • Brennan I
        • Simon T.
        Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis.
        BMJ. 2011; 342: d3313
      15. Cure Violence. The Big Idea. [Internet] 2021. [Cited 14 Jan 2022] Available from: Bleeding Out: The Devastating Consequences of Urban Violence2019

      16. Abt T. Why violence clusters in cities — and how to reduce it. [Internet] TEDMED; 2020. [Cited 14 Jan 2022]. Video 14:43. Available from:

      17. Hassan G. Violence is preventable not inevitable. The Story and Impact of the Scottish Violence Reduction Unit. [Internet] 2018. [Cited 14 Jan 2022] Available from:

      18. Redthread. Our approach. [Internet] 2021. [Cited 14 Jan 2022] Available from:

      19. Public Health England. A whole-system multi-agency approach to serious violence prevention: a resource for local system leaders in England. Public Health England; London. 2019.

      20. GMC. Confidentiality: reporting gunshot and knife wounds [Internet] Apr 2017. [Cited 14 Jan 2022]. Available from:

        • MC Nielsen TG
        • Ridley S
        • Lecky FE
        • Morris S
        Outcomes and costs of penetrating trauma injury in England and Wales.
        Injury. 2008; 39: 1013-1025
      21. Royal College of Emergency Medicine. Best practice guideline: guideline for information sharing to reduce community violence. [Internet] London;2017. [Cited 14 Jan 2022] Available from:

        • Mercer Koller L
        • Jacoby S
        • Ridgeway G
        • Sumner A
        Cardiff Model Toolkit: community guidance for violence prevention atlanta: division of violence prevention, national centre for injury prevention and control.
        Centers for Disease Control and Prevention. 2017 ([Internet][Cited 14 Jan 2022] Available from)