Civilian Cerebral Gunshot wounds - The South African Experience General

Dr Victor Kong, lead author of the study.Dr Victor Kong, lead author of the study.

A group of UKZN health professionals has published results of their research into civilian cerebral gunshot wounds (GSWs) providing a unique South African perspective on the issue.

The incidence of such wounds is relatively uncommon outside military activity and existing literature on the topic in civilian life comes mainly from the United States.

This prompted the UKZN team to do their research which by all accounts has never been done before in the developing world.

Published in the ANZ Journal of Surgery, the study was undertaken by the team who are all experienced in trauma and critical care.  They included Dr Victor Kong, Professor Petra Brysiewicz, Professor Damian Clarke, Professor Benn Sartorius, Dr John Lambert Bruce, Dr Grant Llewellyn Laing and Ms Jocinta Odendaal as well as a British doctor, Dr Ellen Jerome, who worked at Edendale Hospital in Pietermaritzburg for a year.

The team conducted a retrospective study of all patients with isolated cerebral gunshot wounds managed by the Pietermaritzburg Metropolitan Trauma Service (PMTS) over a five-year period from 2010 to 2014, recording 102 injuries, 94 of which were due to interpersonal assault while six were due to attempted suicides. Of the total number of patients, 94 were male.

The study also found that 54% of the patients were based in urban areas and were transported to the PMTS on average after six hours of the incident while those living in rural areas arrived within 15 hours. Patients from rural areas were initially transported by ambulance to their local rural district hospitals before being transferred to the Pietermaritzburg Trauma Centre. Delays in patients receiving prompt and timeous treatment resulted in a significant difference in mortality rates between those from urban areas as opposed to those from rural areas.

Research results indicate that rural patients have a worse outcome than urban patients in KwaZulu-Natal, raising the issue of discrepancies in outcome among communities based on access to resources. The study provides support for ongoing attempts by UKZN to develop a disseminated training programme in the province in an attempt to improve the care available to rural surgical patients and ensure that these discrepancies are reduced and ultimately eliminated.

This South African study is unique due to the high number of civilians being victims of interpersonal gunshot wounds as well as the fact that rural trauma patients have a higher mortality rate than their urban counterparts. Outside the few major metropolitan trauma centres, almost all rural hospitals are often understaffed and ill equipped for managing trauma, necessitating transfer to urban hospitals.

The authors reflected that despite the generally perceived negative outlook of patients with cerebral GSWs, about 70% of survivors had a reasonably good clinical outcome bearing in mind that long-term neurological outcome data and functional status of survivors were lacking.

The authors recommend that management must be individualised in order to optimise the outcome for these patients.

They added that in order to improve patient outcomes, further study was required to explore the many reasons for delayed presentation within the trauma system.

MaryAnn Francis