Q&A: Thesis maps firearm injuries in Sweden

Firearm injuries have increased significantly in Sweden over the past decade, and with them the need for medical understanding about how best to treat these injuries.

In a new thesis from Karolinska Institutet, Karolina Nyberger, doctoral student at the Vascular Surgery group at the Department of Molecular Medicine and Surgery, examines the injury pattern in gun violence, with a particular focus on bleeding and vascular injuries. Nyberger shared her research in the interview below.

What is your thesis about?

Gunshot injuries have increased in Sweden in recent years. Since 2011, fatal firearm violence has more than doubled, making Sweden stand out compared to other European countries. Firearm violence affects not only individuals but also society at large, with significant economic and medical consequences. This makes it crucial to understand the health care system's role in managing these injuries.

My thesis, "Vascular trauma and haemorrhage after firearm injuries," maps firearm injuries with a particular focus on bleeding and vascular injuries. The work is primarily based on Swedish data but also includes international comparisons in civilian public mass shootings. The aim is to contribute with knowledge that can be used to prevent deaths and improve the management of firearm injuries in the future.

What are the key findings?

The thesis provides new insights into injury patterns from gunshot wounds. We see that it is mainly young men in urban areas who are affected, but the incidence is also increasing all across Sweden. The most common injury sites are the extremities, followed by the abdomen. One in six patients dies within 30 days of their firearm injury, with the majority of deaths occurring within the first hour, often due to bleeding or traumatic brain injury.

The fact that more people die before reaching hospital suggests that the violence has become more lethal

Vascular injuries are particularly associated with high mortality. Injuries to the head, neck, and chest are especially life-threatening. By analyzing the exact time of deaths, we have shown that vascular injuries in the chest contribute to particularly early death. In mass shootings, injuries to the extremities, chest, and abdomen dominate, but around a quarter of deaths are linked to bleeding from major central vessels. This further emphasizes that early and effective bleeding control is crucial for improved survival.

How can this knowledge benefit people?

The knowledge from the thesis can help improve the management of firearm injuries by clarifying the need for rapid interventions, especially to stop life-threatening bleeding. A shortened time to definitive bleeding control is essential for better survival. The results can also serve as a basis for future guidelines in the management of firearm injuries.

What are your goals for the future?

This work has sparked many new research ideas, particularly in the area of trauma care for firearm injuries. I am also interested in expanding my international network and expertise through a postdoctoral position abroad. At the same time, our collaboration with the National Board of Forensic Medicine has opened the possibility of conducting a larger study comparing deceased and alive firearm victims in greater depth. The goal is to better understand which factors determine whether a patient survives or not—knowledge that could have a direct impact on future medical efforts to save more lives.

More information:
Karolina Karlsson Nyberger, Vascular trauma and haemorrhage after firearm injuries, (2025). DOI: 10.69622/29279933.v1

Provided by Karolinska Institutet