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HomeResearch AfricaRural head gunshot victims at a grave disadvantage - UKZN 5-year study

Rural head gunshot victims at a grave disadvantage – UKZN 5-year study

GunshotCerebral gunshot victims from rural area admitted to the Pietermaritzburg Metropolitan Trauma Service Centre took more than twice as long to present for treatment than urban victims and had a fourfold higher mortality rate, a five-year University of KwaZulu-Natal study found. The study looked at 112 victims, most of whom male and 92% of injuries were as a result of interpersonal violence.

The Times reports that the study confirms what doctors have long suspected: that rural areas offer a poorer level of care and that patients cannot be transferred to large specialist hospitals quickly enough.

The doctors from the department of surgery, University of KwaZulu-Natal, recently published their study, saying they were motivated to do the work as there is too little known regarding patients with head gunshot wounds outside of the US military. Their study looked at 112 victims of head wounds over five years. Most were male and 92% of injuries were as a result of interpersonal violence. Six were attempted suicides.

The study found that 54% of the patients were based in urban areas and were transported to the Pietermaritzburg trauma centre in an average of six hours. However, those from rural areas arrived only within 15 hours.

Patients from rural areas were initially transported by ambulance to their local rural district hospitals before being transferred to the city. The report say the long delay meant 36% of rural patients died versus 9% of urban patients.

"Outside the few major metropolitan trauma centres, almost all rural hospitals are often understaffed and ill-equipped for managing trauma, necessitating transfer to the urban hospitals," they wrote.

According to the report, the authors reflected that, despite the generally perceived negative outlook of patients with cerebral gunshot wounds, approximately 70% of survivors had a reasonably good clinical outcome – bearing in mind that long-term neurological outcome data and the functional status of survivors was lacking.

Abstract
Background: Cerebral gunshot wounds represent one of the most lethal forms of traumatic brain injury, but there is a paucity of literature on the topic, especially from the developing world. We reviewed our experience and describe the spectrum and outcome of civilian cerebral gunshot wounds in a major metropolitan trauma centre in South Africa.
Methods: This was a retrospective study of all patients with isolated cerebral gunshot wounds managed by the Pietermaritzburg Metropolitan Trauma Service over a 5-year period from 2010 to 2014.
Results: One hundred and two patients were included, 92% (94/102) were male and the mean age was 29 years. Fifty-four per cent (55/102) of all patients were from urban areas. The mean time from injury to arrival was 6 h (standard deviation: 5) for urban patients and 15 h (standard deviation: 5.2) for rural patients (P < 0.001). Ninety-four per cent (94/102) of all injuries were related to interpersonal violence and involved low velocity firearms. Twenty per cent of all patients (20/102) had a Glasgow Coma Scale 3–8, 20% (20/102) 9–12 and 61% (61/102) 12–15. All 102 patients underwent computed tomography scans. Thirty per cent (31/102) required neurosurgical interventions. The overall mortality rate was 22% (22/102). There was a significant difference in mortality between urban and rural patients (9% versus 36%, P < 0.001).
Conclusions: Cerebral gunshot wounds are associated with significant mortality and protracted delay to definitive care is common in our setting. Those who survive the delayed transfer to definitive care generally do well and have reasonably good clinical outcomes.

Authors
V Kong; J Odendaal; B Sartorius; D Clarke; P Brysiewicz; E Jerome; J Bruce; G Laing

[link url="http://www.timeslive.co.za/thetimes/2017/02/14/Rural-patients-have-a-gun-to-their-heads"]The Times report[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/ans.13846/abstract"]ANZ Journal of Surgery abstract[/link]

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