Injury surveillance at a level I trauma centre in Johannesburg, South Africa: research

An analysis of 16 357 trauma patients seen over a one year period at the trauma casualty of an academic hospital in Johannesburg was carried out to determine the profile of injuries sustained by victims in the Johannesburg region. A retrospective survey was conducted between January and December 2001 to compile a composite trauma morbidity and mortality profile, and to create baseline data for future comparison. The objectives of the survey were: to describe the frequencies, distribution and categories of injuries; to assess, on admission to the trauma casualty, the severity of injuries according to the TRISS method; and the outcomes and/or placement of patients after initial treatment in the trauma casualty. Guided by a structured checklist, data were collected by reviewing trauma registers and patients' documents. The TRISS method was used to determine injury severity and descriptive statistics were used to present and describe the results. A preview of the survey results indicates that males are a high-risk category for trauma, particularly over weekends, during their nocturnal activities. More than two thirds of all patients sorted in the 16-35 year age group. Injuries to the limbs and head and neck regions accounted for the highest percentage of cases with assault or interpersonal violence a major cause in an estimated 70% of cases. More than 60% of a random sample of 163 patients had sustained serious injuries with an ISS between 16 and 75; the majority however had a survival probability (Ps) of > 50%. This paper describes the methodology and results of the survey in relation to a proposed long-term injury surveillance project. 'n Analise van 16 357 trauma-pasiënte gesien in 'n een-jaar periode in die trauma-ongevalle van 'n akademiese hospitaal in Johannesburg, is uitgevoer ten einde 'n profiel van beserings wat opgedoen is deur slagoffers, in die Johannesburg-area, te bepaal. 'n Retrospektiewe opname is gebruik om 'n omvattende trauma-morbiditeit en mortaliteitsprofiel saam te stel, en om basislyndata vir toekomstige vergelykings te genereer. Die fokus van die opname was gerig op frekwensie, verspreiding en kategorisering van beserings, die ernstigheidsgraad van beserings (ISS), asook die uitkoms en plasing van pasiënte na inisiële behandeling in die trauma-ongevalle. 'n Gestruktureerde kontrolelys is gebruik om data te versamel deur die evaluering van traumaregisters en dokumentasie van pasiënte. Die TRISS-metode is gebruik om te bepaal wat die ernstigheidsgraad van die beserings was. Verder is beskrywende statistiek gebruik om die data aan te bied en te beskryf. Die resultate van die opname dui aan dat mans in die hoërisiko-kategorie vir trauma val, veral tydens naweke en gedurende nagtelike aktiwiteite. Meer as tweederdes van alle pasiënte val in die 16- 35 jaar ouderdomsgroep. Beserings aan die ledemate, kop- en nekarea het in die meeste gevalle voorgekom. In ongeveer 70% van die gevalle was aanranding of interpersoonlike geweld die hoofoorsaak van hierdie beserings. Meer as 60% van 'n ewekansige steekproef van 163 pasiënte het ernstige beserings opgedoen, met 'n ISS van tussen 16 en 75. Die meerderheid het egter 'n oorlewingsmoontlikheid (Ps ) van > 50% gehad. Hierdie artikel beskryf die metodologie en resultate van die opname in die konteks van 'n voorgestelde projek vir die waarneming van langtermynbeserings. (Health SA Gesondheid: interdisciplinary research journal: 2003 8(3): 3-12

The malignant epidemic-changing patterns of trauma

Objectives and Setting. The worldwide burden of trauma is increasing, but is unequally distributed between nations. Trauma in South Africa targets the young and productive in society and imposes a major burden on the health infrastructure. We undertook a review of injury trends among patients attending the Johannesburg Hospital Trauma Unit (JHTU) and the Johannesburg Medicolegal Laboratory (JMLL) in order to document the evolution in patterns of trauma over a 17-year period of great social and political change. Design, subjects and outcome measures. This was a retrospective review of all priority-one patients attending the JHTU from January 1985 to December 2001. The JHTU trauma database was used to retrieve information on patient demographics, wound mechanism and injury severity. The database at the JMLL, maintained since 1996, was examined and the manner and place of death were analysed.Results. The JHTU has seen an unprecedented increase in the number of trauma patients over the last 17 years. The patients' demographic profiles have altered and injury is now predominantly due to interpersonal violence. Unnatural deaths examined at the JMLL have declined by 19% since 1996; however, the proportion of those deaths due to gunshot wounds has risen.Conclusions. The social and political changes in South Africa in recent years have led to changes in the injury profiles seen at the JHTU. Part of the increase can be explained by desegregation and a reduction in the provision of local hospital services; however, the impact of urbanisation within South Africa, cross-border migration and the high incidence of substance abuse are recognised. Evidence supports the implementation of legislative, environmental, social and behavioural interventions to contain and reduce the incidence and impact of violence and injury. Concerted efforts must be made at all levels to curb South Africa's  trauma  epidemic