The burden of gunshot injuries on orthopaedic healthcare resources in South Africa

Martin, Case; Thiart, G. D.; McCollum, Graham; Roche, Stephen; Maqungo, Sithombo

doi:10.7196/samj.2017.v107i7.12257

Cited by 27 publications

(33 citation statements)

References 3 publications

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“…When comparing to other high-income countries, firearm homicides are 19 times higher in USA [4]. Although annual homicides have decreased in South Africa, the country still faces a high rate of firearm-related violence that creates a huge burden on the healthcare resources [5].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of firearm injuries in a Scandinavian trauma center

Bäckman

Riddez

Adamsson

et al. 2018

Eur J Trauma Emerg Surg

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Background There is a concern that civilian gunshot injuries in Europe are increasing but there is a lack of contemporary studies. The purpose of this study was to investigate the current epidemiology and outcome of firearm injuries. Methods Retrospective cohort study of all patients (n = 235) treated for firearm injuries admitted to a Scandinavian trauma center between 2005 and 2016. Local and national trauma registries were used for data collection. Results Mean age was 31.3 years (SD ± 12.9; range 16-88 years); 93.6% males; mean ISS was 14.3 (SD ± 15.9); 31.9% (75/235) had ISS > 15. There was a significant increase in penetrating trauma (P < 0.001) and firearm injuries (P < 0.001) over the years. The most common anatomical location of firearm injury was the lower extremity, (n = 138/235; 38%), followed by the abdomen (n = 69;19%), upper extremity (n = 53;15%), chest (n = 50; 14%), and head and neck (n = 50; 14%). Ninety patients (38.3%) had more than one anatomic injury location. There were in total 360 firearm injuries and 168 major surgical procedures were performed. 53% (n = 125) of patients underwent at least one surgical procedure. The most common procedures were fracture surgery 42% (n = 70/168), followed by laparotomy 30%% (n = 51), chest tube 17% (n = 29), and thoracotomy 11% (n = 18). Forty-one patients (17%) had at least one major vascular injury (n = 54). The most common vascular injury was lower extremity vessel injuries, 26/54 (48%), followed by vessels in chest and abdomen. There was a significant increase in vascular injuries during the study period (P < 0.006). The 30-day mortality was 12.8% (n = 30); 24 patients died within 24 h mainly due to injuries to the chest and the head and neck region. Conclusions Firearm injuries cause significant morbidity and mortality and are an important medical and public health problem. In a Scandinavian trauma center there has been an increase of firearm injuries in recent years. The lower extremities followed by the abdomen are the dominating injured regions and there has been an increase in associated vascular injuries.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of firearm injuries in a Scandinavian trauma center

Bäckman

Riddez

Adamsson

et al. 2018

Eur J Trauma Emerg Surg

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“…[1][2][3][4][5][6] South Africa's lethal violence rates are close to those of countries at war and Cape Town specifically is one of the most violent cities in the world regarding homicides. 4,7 In recent years a high rate of interpersonal violence combined with gun trafficking and use of guns as main weapon in gang wars has caused a surge of gun-related injuries (Figure 1). This causes an extreme burden to the health care system in costs as well as hospital stay.…”

Section: Introductionmentioning

confidence: 99%

“…This causes an extreme burden to the health care system in costs as well as hospital stay. 7 Reports on the epidemiology of civilian gunshot injuries and orthopaedic injury patterns are limited. 8,9 Most evidence and guidelines are based on small American and European retrospective case series or military experience with high-velocity injuries.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Engelmann¹,

Maqungo²,

Laubscher³

et al. 2019

SA orthop. j.

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Aims: To describe the epidemiology and injury severity of patients with extremity gunshot injuries in an area with a high rate of interpersonal violence. Patients and methods: This is a prospective cohort study of patients who presented with an extremity gunshot injury and were recorded as part of a trauma registry at a large tertiary care hospital in Cape Town, South Africa, between June 2015 and April 2016. Patient demographics, injury severity scores, injury patterns and referral pathways were evaluated. Results: Of 1 123 gunshot trauma admissions in ten months, 290 (25.8%) patients (91.5% males, n=269) with a median age of 26 years (IQR 13.0) presented with extremity injuries. Median injury severity score (ISS) was 4.0 (IQR 8.0). Only one-fifth of patients had an ISS of 15 or more (n=50, 17%). Upper extremity injuries were associated with a higher risk of fractures (RR 2.15, p=0.05), higher number of nerve injuries (p=0.01), and a two times higher mean ISS (p=0.01). Admissions between 7pm and 7am with limited staffing at the emergency department were twice as high as the day admissions (n=169, 57.5% versus n=79, 26.9%). Conclusion: There is a high trauma load on the emergency department and orthopaedic service due to extremity gunshot injuries. Although upper extremity gunshot wounds constituted a red flag for higher injury severity, the overall injury severity was low. Inadequate timing and selection of emergency referrals of patients with low ISS are avoidable aggravators of this burden and should be targeted to increase efficiencies in the care of these patients.

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“…In Africa, rearm injuries represent a major health problem. South Africa is an example of a country that faces this problem, which creates a huge burden on the healthcare resources [7]. Firearm injuries were estimated to amount to almost 55,000 in 2012 in South Africa [8].…”

Section: Introductionmentioning

confidence: 99%

Gunshot injuries: patterns, presentations, and outcomes of civilian hospital experiences in a developing country setting

Gismalla

Bakhiet

Koko

et al. 2020

Preprint

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BackgroundGunshot injuries are considered a burden as well as one of the intricate emergencies in civilian medical practice. In this study we aim to determine the pattern of presentation and management outcome in a general hospital in a sub-Saharan country.MethodsThis is a retrospective, hospital-based study conducted between January 2015- December 2019 in a general teaching hospital, to review the clinical presentation and management outcome of gunshot injuries. All patients’ records were reviewed during the study period.ResultsOne hundred fifty-seven patients were included in the study, with male predominant 83%. 40% are between 19-30 years of age, with patients under 18 years of age comprising 17% of the population. The anatomical sites most commonly affected by gunshot were the lower limb (41.4%) and upper limb (22.9%), and the least impacted site is the perineum (1.9%). The most common diagnoses among the patients in this study were limb fractures (49.7%) and soft tissue injuries (28.7%). Specific treatment in this study is wound debridement, which was done for 91 (58.0 %) patients. Bone fixation, laparotomy and chest tube insertion were done for the rest of the patients. More than 120 (75%) of patients were treated and discharge in a good condition and 27 (17.2%). The mortality rate in this study group was 15.3 %.Conclusion Most of the patient in this study were young males. Upper and lower limb fractures are the most common presentations. Wound debridement, bone fixation and laparotomy are the most common treatments with significant success rates, despite prolonged hospital stay.

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The burden of gunshot injuries on orthopaedic healthcare resources in South Africa

Cited by 27 publications

References 3 publications

Epidemiology of firearm injuries in a Scandinavian trauma center

Epidemiology of firearm injuries in a Scandinavian trauma center

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Gunshot injuries: patterns, presentations, and outcomes of civilian hospital experiences in a developing country setting

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