A silver bullet? The role of radiology information system data mining in defining gunshot injury trends at a South African tertiary-level hospital.

Dale K Creamer,Richard D Pitcher,Clive Daniels,Asif Bagadia

doi:10.4102/sajr.v25i1.2018

Abstract

BackgroundSouth Africa (SA) has no national injury surveillance system, and hence, non-fatal gunshot injuries are not routinely recorded. Most firearm-related injuries require multi-detector computer tomography (MDCT) assessment at a tertiary-level facility. MDCT scanning for victims with gunshot injuries thus provide an indication of the societal burden of firearm trauma. The potential of the modern radiology information system (RIS) to serve as a robust research tool in such settings is not fully appreciated.ObjectiveThe aim of this study was to evaluate the use of institutional RIS data in defining MDCT scanning trends for gunshot victims presenting to a tertiary-level SA hospital.MethodA single-institution, retrospective, comparative study was conducted at the Tygerberg Hospital (TBH) Trauma Unit for the years 2013 and 2018. Using data-mining software, customised RIS searches for information on all gunshot-related emergency computed tomography scans in the respective years were performed. Demographic, temporal, anatomical and scan-protocol trends were analysed by cross tabulation, Chi-squared and Fisher’s exact tests.ResultsGunshot-related emergency MDCT scans increased by 62% (546 vs. 887) from 2013 to 2018. Lower-limb CT angiography was the commonest investigation in both periods. A higher proportion of victims in 2018 sustained thoracic injuries (12.5% vs. 19.8%; p < 0.01) and required imaging of more than two body parts (13.1% vs. 19.2%; p < 0.01).ConclusionBy using RIS data to demonstrate the increasing gunshot-related MDCT workload in the review period, as well as a pattern of more complex and potentially life-threatening injury, this study highlights the burden of firearm trauma in the society and the potential role of the modern RIS as a robust research tool.

Highlights

The deaths resulting from interpersonal violence have declined steadily in the new millennium from 144 000 in the year 2000 to 21 000 in 2018–2019 in South Africa (SA).1,2 This is arguably in response to the Firearms Control Act (FCA) of 2000, which was implemented in July 20043 and introduced more stringent eligibility and competency requirements for firearm owners.4SA maintains the sixth highest homicide rate in the world (35/104 people) and the second highest rate in sub-Saharan Africa.5 the Western Cape Province (WCP) is violent, with 59 murders/104 people and an apparent increase in the proportion of gunrelated homicides
The key findings of this study were that a higher proportion of 2018 victims sustained thoracic trauma
Through a simple series of radiology information system (RIS) searches and subsequent analyses, compelling evidence was provided of the relentless increase in firearm violence in certain Cape Town suburbs

Summary

Introduction

The deaths resulting from interpersonal violence have declined steadily in the new millennium from 144 000 in the year 2000 to 21 000 in 2018–2019 in South Africa (SA). This is arguably in response to the Firearms Control Act (FCA) of 2000, which was implemented in July 20043 and introduced more stringent eligibility and competency requirements for firearm owners.4SA maintains the sixth highest homicide rate in the world (35/104 people) and the second highest rate in sub-Saharan Africa. the Western Cape Province (WCP) is violent, with 59 murders/104 people and an apparent increase in the proportion of gunrelated homicides. The deaths resulting from interpersonal violence have declined steadily in the new millennium from 144 000 in the year 2000 to 21 000 in 2018–2019 in South Africa (SA).. The deaths resulting from interpersonal violence have declined steadily in the new millennium from 144 000 in the year 2000 to 21 000 in 2018–2019 in South Africa (SA).1,2 This is arguably in response to the Firearms Control Act (FCA) of 2000, which was implemented in July 20043 and introduced more stringent eligibility and competency requirements for firearm owners.. South Africa (SA) has no national injury surveillance system, and nonfatal gunshot injuries are not routinely recorded. MDCT scanning for victims with gunshot injuries provide an indication of the societal burden of firearm trauma. The potential of the modern radiology information system (RIS) to serve as a robust research tool in such settings is not fully appreciated

Methods

Results

Discussion

Conclusion