Sudan Journal of Medical Sciences
ISSN: 1858-5051
High-impact research on the latest developments in medicine and healthcare across MENA and Africa
Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting
Published date: Mar 31 2023
Journal Title: Sudan Journal of Medical Sciences
Issue title: Sudan JMS: Volume 18 (2023), Issue No. 1
Pages: 71–83
Authors:
Abstract:
Background: Gunshot injuries are considered a health burden as well as one of the intricate emergencies in civilian medical practice. In this study, we aim to determine the pattern of presentation and management outcome in a general hospital setting in a sub-Saharan African country.
Methods: This is a retrospective, hospital-based study conducted between January 2015 and December 2019 in a general teaching hospital to review the clinical presentation and management outcome of gunshot injuries. All patients’ records were reviewed during the study period.
Results: The total number of patients involved in the study was 157 with 83% male predominant. About 50% were from the age group 20–29 years that were most affected. The commonest anatomical site affected in the study was the lower limb (41.4%) and upper limb (22.9%), and most of the patients had been diagnosed with limb fractures (49.7%) and soft tissue injuries (28.7%). Wound debridement is the commonest procedure performed for 91 (58.0%) patients. The site of the pullet has a significant relation to the management outcome with a P-value of 0.002. Additionally, about 45% (72 patients) have stayed more than 20 days and it was affected significantly by the types of treatment provided, which has a significant relation to a hospital stay with a P-value of 0.00.
Conclusion: Most of the patients in this study were young males. Upper and lower limb fractures were the most common presentations. Wound debridement, bone fixation, and laparotomy were the most common treatments with significant success rates, despite prolonged hospital stays.
Keywords: epidemiology, gunshot injuries, gunshot wound, sub-Saharan countries, Sudan
References:
[1] Gopalakrishnan, S. (2012). A public health perspective of road traffic accidents. Journal of Family Medicine and Primary Care, 1(2), 144–150.
[2] Iloh, G. U., Chuku, A., Ofoedu, J. N., Ugwele, O. H., Onyekwere, J. O., & Amadi, A. N. (2013). The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a state without formal prehospital emergency medical services. Annals of Tropical Medicine and Public Health, 6(4), 435–442.
[3] Martin, C., Thiart, G., McCollum, G., Roche, S., & Maqungo, S. (2017). The burden of gunshot injuries on orthopaedic healthcare resources in South Africa. South African Medical Journal, 107(7), 626–630.
[4] Chalya, P. L., Mchembe, M., Mabula, J. B., Kanumba, E. S., & Gilyoma, J. M. (2011). Gunshot injuries: A Tanzania experience in a teaching hospital in the lake zone. East and Central African Journal of Surgery, 16, 19–25.
[5] Hugenberg, F., Anjango, W. O., Mwita, A., & Opondo, D. (2007). Firearm injuries in Nairobi, Kenya: Who pays the price? Journal of Public Health Policy, 28(4), 410–419.
[6] ElhajI Tibin, A. M. A., & Ahmed, M. E. (2016). Pattern and outcome of abdominal gunshot wounds in El-Fashir Teaching Hospital. Khartoum Medical Journal, 09( 03), 1291–1296.
[7] Aspelund, A. L., Patel, M. Q., Kurland, L., McCaul, M., & Van Hoving, D. J. (2019). Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa. African Journal of Emergency Medicine, 9(4), 193–196.
[8] El Tayeb, S., Abdalla, S., Heuch, I., & Van den Bergh, G. (2015). Socioeconomic and disability consequences of injuries in the Sudan: A community-based survey in Khartoum State. Injury Prevention, 21(1), 56–62.
[9] Khani, G. M., Humail, S. M., Hafeez, K., & Ahmed, N. (2015). Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan. Chinese Journal of Traumatology, 18(03), 161–163.
[10] Foran, C. P., Clark, D. H., Henry, R., Lalchandani, P., Kim, D. Y., Putnam, B. A., Schellenberg, M., Lane, C. J., Inaba, K., & Demetriades, D. G. (2019). Current burden of gunshot wound injuries at two Los Angeles County Level I Trauma centers. Journal of the American College of Surgeons, 229(2), 141–149.
[11] Muggah, R. (2006). Emerging from the shadow of war: A critical perspective on DDR and weapons reduction in the post-conflict period. Contemporary Security Policy, 27(01), 190–205.
[12] Zgheib, H., Shayya, S., Wakil, C., Bachir, R., & El Sayed, M. J. (2019). Gunshot injuries in Lebanon: Does intent affect characteristics, injury patterns, and outcomes in victims? Journal of Emergencies, Trauma, and Shock, 12(2), 117–122.
[13] Norton, J., Whittaker, G., Kennedy, D. S., Jenkins, J. M., & Bew, D. (2018). Shooting up? Analysis of 182 gunshot injuries presenting to a London major trauma centre over a seven-year period. The Annals of The Royal College of Surgeons of England, 100(6), 464–474.
[14] Engelmann, E. W., Maqungo, S., Laubscher, Μ., Hoppe, S., Roche, S., Nicol, A., Navsaria, P., Held, M. (2019). Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: A report from the Cape Town trauma registry. SA Orthopaedic Journal, 18(2), 31–36.
[15] Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Preventive medicine. 2015 Oct 1;79:5-14.
[16] Onyia EE, Chikani MC, Mezue WC, Uche EO, Iloabachie I, Mesi M, Ejembi S, Agunwa C. Civilian penetrating gunshot injury to the neurocranium in Enugu. Nigerian journal of surgery. 2017 May 22;23(1):47-52.
[17] Khan MN, Shah SA, Malik Z, Ahmed A, Asim MA. Pattern of facial gunshot and blast injuries amongst law enforcing forces. PAFMJ. 2016 Aug 31;66(4):515-19.
[18] Mansor S, Bodalal Z. The impact of the method of gunshot injury: War injuries vs. stray bullets vs. civilian fighting. J Coll Physicians Surg Pak. 2015 Apr 1;25, ( (4)): p. 281-5.
[19] Dahab M, Abdelmagid N, Kodouda A, Checchi F. Deaths, injuries and detentions during civil demonstrations in Sudan: a secondary data analysis. Conflict and health. 2019 Dec;13(1):16-22.
[20] Stefanopoulos PK, Pinialidis DE, Hadjigeorgiou GF, Filippakis KN. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets. European journal of trauma and emergency surgery. 2017 Oct;43(5):579-86.
[21] Livingston DH, Lavery RF, Lopreiato MC, Lavery DF, Passannante MR. Unrelenting violence: an analysis of 6,322 gunshot wound patients at a Level I trauma center. Journal of trauma and acute care surgery. 2014 Jan 1;76(1):2-11.
[22] Kong VY, Blodgett JM, Weale R, Bruce JL, Laing GL, Smith M, Bekker W, Clarke DL. Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience. South African journal of surgery. 2019 Dec;57(4):25-8.
[23] Davis JS, Castilla DM, Schulman CI, Perez EA, Neville HL, Sola JE. Twenty years of pediatric gunshot wounds: an urban trauma center’s experience. Journal of surgical research. 2013 Sep 1;184(1):556-60.
[24] Chamisa I. Pattern of civilian gunshot wounds in Durban, South Africa. European journal of trauma and emergency surgery. 2011 Feb;37(1):37-40.
[25] Al Rawahi AN, Al Hinai FA, Boyd JM, Doig CJ, Ball CG, Velmahos GC, Kirkpatrick AW, Navsaria PH, Roberts DJ. Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis. World Journal of Emergency Surgery. 2018 Dec;13(1):p. 55-61.
[26] Philipp Lichte, R. O., Binnebösel, M., Wildenauer, R., Pape, H. C., & Kobbe, P. (2010). A civilian perspective on ballistic trauma and gunshot injuries. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(35), 2–8.