The spectrum of self inflicted injuries managed at a major trauma centre in South Africa

  • Samuel Edwin Moffatt University Hospitals Coventry and Warwickshire NHS Trust
  • Victor Y Kong University of the Witwatersrand
  • Ross David Weale
  • Johannes Jacobus Petrus Buitendag Stellenbosch University
  • Abraham B Ras University of KwaZulu-Natal
  • Michelle T Smith University of KwaZulu-Natal
  • John L Bruce University of KwaZulu-Natal
  • Grant Llewellyn Laing University of KwaZulu-Natal
  • Damian L Clarke University of the Witwatersrand
Keywords: Self harm, Suicide, major trauma centre, South Africa

Abstract

Background: Self-harm behaviour is a major public health problem that is commonly underreported. This study reviews the spectrum of these self inflicted injuries managed by a major trauma centre in South Africa.

Methods: A retrospective review of the regional trauma registry was undertaken over a five-year period from December 2012 to December 2017 at the Pietermaritzburg Metropolitan Trauma Service (PMTS) in South Africa. All patients who were admitted after they had sustained an injury as a result of self-harm were included.

Results: During the five-year study period, a total of 179 patients were included. The mean age was 29 years (SD12) and there were 139 (77%) males and 40 (23%) females. Of these, 16 had a previously established psychiatric diagnosis and two had a prior history of having sustained self-harm. The previously diagnosed psychiatric illnesses included mood dysphoria disorders (5), schizophrenia (3), substance abuse and dependency (1), anti-social personality disorder (1) and unspecified (6). The mechanism was penetrating trauma in 47 (26%). The penetrating mechanisms included stab wounds (SW) in 33 gunshot wounds (GSW) in 10, broken glass in 2 and a single impalement. Blunt mechanisms accounted for the remaining 131 (73%) injuries. The most common mechanism of blunt self-harm was hanging in 101 patients. This was followed by vehicular related trauma (8), jumping in front of a train (1) and jumping from a height (1). In 17 patients the exact mechanism of the blunt trauma was unclear. There was no statistical difference in the mechanism of injury between male and female patients. There were 38 (28%) men and 9 (23%) women who sustained a penetrating injury and there were 100 (72%) male and 31 (78%) female patients who had a blunt mechanism of injury. A total of 53 CT scans were obtained, 40 chest X-rays, 9 abdominal X-rays and 2 ultrasounds. There were 113 neck injuries, 68 head injuries, 24 abdominal injuries, 15 upper limb and 15 lower limb injuries and four facial injuries. A total of 32 operations were performed. These included laparotomy (14), neck exploration (5), tracheostomy (4). A total of 22 patients developed a complication.

Conclusion: Self-inflicted injury is not uncommon and frequently requires investigation and or surgical treatment. Patients who sustain such an injury constitute a distinct vulnerable group who are under researched. Future research on this vulnerable patient group is needed.

Author Biographies

Samuel Edwin Moffatt, University Hospitals Coventry and Warwickshire NHS Trust

Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom

Victor Y Kong, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Johannesburg; and Department of Surgery, University of KwaZulu-Natal, South Africa

Ross David Weale

Department of Surgery, North West Deanery, Manchester, United Kingdom

Johannes Jacobus Petrus Buitendag, Stellenbosch University

Department of Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Abraham B Ras, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Michelle T Smith, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

John L Bruce, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Grant Llewellyn Laing, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Damian L Clarke, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Johannesburg and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Published
2019-05-14
How to Cite
Moffatt, S., Kong, V., Weale, R., Buitendag, J., Ras, A., Smith, M., Bruce, J., Laing, G., & Clarke, D. (2019). The spectrum of self inflicted injuries managed at a major trauma centre in South Africa. South African Journal of Surgery, 57(2), 65. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2897
Section
Trauma