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'Community justice' sjambokking and acute kidney injuries – UKZN study

RASjambokThe acute kidney injury risk stratification score using venous bicarbonate is valid and should continue to be used as a tool in the management of patients with sjambok injuries and assessing the need for renal replacement therapy, found a University of KwaZulu-Natal study.

Mob justice beatings with sjamboks are so common that a team of doctors has made them the subject of an in-depth study, reports The Times. The four doctors analysed 310 patients admitted to Grey’s and Edendale hospitals‚ in Pietermaritzburg‚ KwaZulu-Natal‚ between June 2010 and December 2012.

Their objective was to study a long-standing method of evaluating acute kidney injury‚ a common consequence of sjambok beatings. “The sjambok‚ a type of traditional stiff whip normally made out of animal leather or plastic‚ is often used to inflict punishment in ‘community justice’ events‚” said lead researcher David Skinner. “Damage to underlying muscle results in the release of myoglobin‚” he said‚ adding that myoglobin deposits and other factors led to kidney damage.

The report says Skinner‚ from the medical school at the University of KwaZulu-Natal‚ wrote that six of the victims in the study‚ who were mostly young men‚ died of their injuries. “These findings contrast with other forms of trauma-associated acute kidney injury‚ where authors have reported mortality rates ranging from 28% to 100%‚” he said.

Abstract
Background: Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these patients.
Objective: To validate this score in the modern era of AKI risk stratification.
Methods: A retrospective study was performed on a local trauma database from June 2010 to December 2012. All patients with crush injury from sjambok/blunt instrument beatings were included in the analysis. VB was compared with the Kidney Disease Improving Global Outcomes scoring system for AKI. Serum base excess (BE) and creatine kinase were also examined as biomarkers. The endpoints were the need for renal replacement therapy (RRT) and mortality.
Results: Three hundred and ten patients were included. The overall mortality rate was 1.9%, 14.8% of patients had AKI, and 3.9% required RRT. Both VB and BE performed well in RRT prediction, with areas under the receiver operating characteristic curve of 0.847 (95% confidence interval (CI) 0.756 – 0.938; p<0.001) and 0.871 (95% CI 0.795 – 0.947; p<0.001), respectively. The sensitivity and specificity of BE were 83.3% and 80.2% at an optimal cut-point of –7.25 mmol/L, while those of VB were 83.3% and 79.5% at an optimal cut-point of 18.85 mmol/L. VB was significantly different across the AKI risk groups (p<0.001), in keeping with the original Muckart risk stratification system.
Conclusion: The risk stratification score using VB is valid and should continue to be used as a tool in the management of patients with sjambok injuries. BE performs well in predicting the need for RRT, with a value of <–7.25 mmol/L indicating severe injury.

Authors
David Lee Skinner, Grant L Laing, John Bruce, Bruce Biccard, David J J Muckart

[link url="http://www.timeslive.co.za/local/2017/05/01/Sjambok-mob-justice-putting-hundreds-at-risk-of-kidney-damage"]The Times report[/link]
[link url="http://www.samj.org.za/index.php/samj/article/view/11888"]SA Medical Journal abstract[/link]

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