Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience

Keywords: gunshot, hijacking, trauma

Abstract

Introduction: Discrepancy in outcomes between urban and rural trauma patients is well known. We reviewed our institutional experience with the management of gunshot wounds (GSWs) in the specific setting of car hijacking and focused on clinical outcome between rural and urban patients.

Methods: A retrospective review was conducted at a major trauma centre in South Africa over an 8-year period for all patients who presented with any form of GSWs in car hijacking settings. Specific clinical outcomes were compared between rural and urban patients.

Results: A total of 101 patients were included (74% male, mean age 34 years). Fifty-five per cent were injured in rural areas and the remaining 45% (45/101) were in the urban district. Mean time from injury to arrival at our trauma centre was 11 hours for rural and 4 hours for urban patients (p < 0.001). Seventy-six per cent (76/101) sustained GSWs to multiple body regions. Sixty-three of the 101 (62%) patients required one or more operative interventions. In individual logistic regressions adjusted for sex and number of regions injured, rural patients were 9 (95% CI: 1.9-44.4) and 7 (95% CI: 2.1-24.5) times more likely than urban patients to have morbidities or required admissions to intensive care respectively. The risk of death in rural patients was 36 (95% CI: 4.5-284.6) times higher than that of urban patients.

Conclusions: Patients who sustained GSWs in carjacking incidents that occurred in rural areas are associated with significantly greater morbidity and mortality compared with their urban counterparts. Delay to definitive care is likely to be the significant contributory factor, and improvement in prehospital emergency medical service is likely to be beneficial in improving patient outcome.

Author Biographies

V Y Kong, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

J M Blodgett, University College London

MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom

R D Weale, North West Deanery

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

J L Bruce, University of KwaZulu-Natal

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

G L Laing, University of KwaZulu-Natal

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

M T D Smith, University of KwaZulu-Natal

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

W Bekker, University of KwaZulu-Natal

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

D 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
2019-11-04
How to Cite
Kong, V., Blodgett, J., Weale, R., Bruce, J., Laing, G., Smith, M., Bekker, W., & Clarke, D. (2019). Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience. South African Journal of Surgery, 57(4), 25-28. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3032
Section
Trauma