Research

The gunshot-related injuries in trauma (GRIT) study: A profile of patients affected by gunshot-related orthopaedic injuries across South Africa

J Masters, M Laubscher, S Graham, L Marais, N Ferreira, M Held, J Viljoen, T Pillay, S Maqungo, M Costa, on behalf of the Orthopaedic Research Collaboration for Africa (ORCA) Investigators

Abstract


Background. South Africa (SA) has one of the highest gun-related mortality rates in the world – 20 people per day. The available data, however, do not reflect the substantial number of patients suffering non-lethal firearm injuries. Gunshot-related injury has been recognised as a highly costly healthcare problem by individual treating centres in SA and other countries; however, no ‘national picture’ has been examined in detail.

Objectives. To explore the burden of gunshot-related orthopaedic injuries across SA.

Methods. A multicentre research network was established in SA, and 37 orthopaedic units across 9 provinces participated. A prospective, observational cohort study was performed during a 2-week period in 2019. Patients were screened, enrolled and reported by local orthopaedic teams. Patients were included if they had at least one acute gunshot-related orthopaedic fracture referred to the orthopaedic service. Patients were asked additional questions around baseline health-related quality-of-life (HRQOL) and personal circumstances. Follow-up was at 8 weeks after injury.

Results. Thirty-seven centres enrolled 135 patients over the 2-week study period. Western Cape Province had the highest number of reported cases (n=52; 39%), followed by Gauteng (n=35; 26%) and KwaZulu-Natal (n=29; 21%). The median age of patients was 30.5 years and the majority were male (89%). Forty-three percent of patients had been either shot or stabbed prior to this injury. Fifty-two percent of all patients required fracture fixation surgery and 11% required wound debridement without fracture fixation. HRQOL data were collected successfully at baseline, but follow-up data were available for <25% of cases.

Conclusions. Gunshot-related orthopaedic injuries represent a significant burden of disease in the SA healthcare environment. This study highlights several areas for further research in the management of the injuries and associated outcomes.


Authors' affiliations

J Masters, Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

M Laubscher, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

S Graham, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK

L Marais, Department of Orthopaedic Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

N Ferreira, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

M Held, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

J Viljoen, Department of Orthopaedic Surgery, Faculty of Health Sciences, University of Pretoria, South Africa

T Pillay, Department of Orthopaedic Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Maqungo, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

M Costa, Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

on behalf of the Orthopaedic Research Collaboration for Africa (ORCA) Investigators,

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Keywords

Trauma; Burden of disease; Fractures; Gun-related violence

Cite this article

South African Medical Journal 2021;111(7):655-660. DOI:10.7196/SAMJ.2021.v111i7.15236

Article History

Date submitted: 2021-06-30
Date published: 2021-06-30

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