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

Evaluation of 294 patients at a level I trauma centre, South Africa

  • Esmee WM Engelmann University of Cape Town
  • Sithombo Maqungo University of Cape Town
  • Maritz Laubscher University of Cape Town
  • Sven Hoppe University of Cape Town
  • Stephen Roche University of Cape Town
  • Andrew Nicol University of Cape Town
  • Pradeep Navsaria University of Cape Town
  • Michael Held University of Cape Town
Keywords gunshot, trauma, upper extremity, lower extremity, epidemiology

Abstract

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.


Level of evidence: Level 4

Author Biographies

Esmee WM Engelmann, University of Cape Town

MD, MSc, LLM; Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

Sithombo Maqungo, University of Cape Town

MD, FC Ortho; Associate Professor, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

Maritz Laubscher, University of Cape Town

MBChB, Dip PEC, FC Orth (SA), MMed Ortho (UCT); Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

Sven Hoppe, University of Cape Town

MD, PhD; Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa; and Department of Orthopaedic Surgery, Division of Spine Surgery, Inselspital Bern, Switzerland

Stephen Roche, University of Cape Town

MBChB, FCS Orth (SA); Associate Professor, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

Andrew Nicol, University of Cape Town

MD; Professor, Department of Traumatology, Groote Schuur Hospital, University of Cape Town, South Africa

Pradeep Navsaria, University of Cape Town

MD; Professor, Department of Traumatology, Groote Schuur Hospital, University of Cape Town, South Africa

Michael Held, University of Cape Town

MD, PhD, FC Ortho; Associate Professor, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

Published
2019-05-02
How to Cite
ENGELMANN, Esmee WM et al. Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry. South African Orthopaedic Journal, [S.l.], p. 31-36, may 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/244>. Date accessed: 25 june 2019.

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