The epidemiology and orthopaedic burden of civilian gunshot injuries over a four-year period at a level one trauma unit
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ORIGINAL PAPER
The epidemiology and orthopaedic burden of civilian gunshot injuries over a four-year period at a level one trauma unit in Cape Town, South Africa M. S. Jakoet 1 & M. Burger 1 Nando Ferreira 1
&
M. Van Heukelum 1 & N. le Roux 1 & M. Gerafa 1 & S. van der Merwe 1 & O. Makabalo 1 &
Received: 17 April 2020 / Accepted: 7 July 2020 # SICOT aisbl 2020
Abstract Purpose The aim of this study was to quantify the overall burden of orthopaedic gunshot-related injuries at our institution over a four year period. Secondary aims included identifying complications from gunshot-related injuries and the additional burden it places on healthcare services. Methods A retrospective review was conducted on all patients with gunshot injuries presenting to our hospital’s trauma unit between January 2014 and December 2017. Patient data was recorded, and demographic data, number and type of implants, blood products used, duration of hospital admission, duration of ICU admission, radiological studies performed, and prevalence of complications were analysed. Results A total of 1449 patients with a mean age of 28.2 ± 9.7 years (range 2.0–71.0) were included in this study. The majority of these gunshot-related orthopaedic injuries were sustained to the lower extremities and were treated non-operatively. The median duration of hospital stay was 7.0 (IQR 4.0–12.0). The most common complications identified were nerve injury (8.3%), vascular injury (6.5%), fracture-related infection (3.2%), non-union (3.1%), and compartment syndrome (1.6%). The total cost of care was ZAR 53,568,537 (USD 4,320,043) with an average cost per patient of ZAR 37,031 (USD 2986). Conclusion This study highlighted the burden of gunshot injuries presenting to our hospital and the strain it places on its healthcare resources. The prevalence of complications was comparable to international studies on the subject. With improved understanding of this burden, more healthcare resources can be allocated to this problem and better prevention strategies can be planned. Keywords Gunshot injuries . Complications . Extremities . Epidemiology
Introduction Gun-related violence represents a large burden on healthcare resources all over the world, with more than 1000 killed and an estimated 2000 people injured every day [1–3]. Gun violence is the most common cause of death in homicide cases worldwide [3]. The rate of fatal firearm injuries per country was estimated at 10.2 per 100,000 in South Africa and 23.7 in Colombia (77% of total homicides) compared with just 4.4 per
* Nando Ferreira [email protected] 1
Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg hospital, Stellenbosch University, Cape Town 7505, South Africa
100,000 in the USA [2]. While Central America, the Caribbean, South America, and Southern Africa are at the epicentre of intentional gun-related violence, most of the research on gunshot-related injuries is conducted in developed countries, such as the USA [2–4]. South Africa is ranked as t
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