Penetrating injury from interpersonal violence and related haemorrhagic shock resuscitation practices in an urban South African emergency medical service

Abstract

Introduction Physical injury is a major cause of premature death and/or disability worldwide. South African mortality statistics indicate approximately half of all injury-related deaths were intentional, often from sharp-force injuries. Injury surveillance data for victims of penetrating injury is scarce in low- to middle-income countries with a reliance on mortality data. The aim was to provide an epidemiological description of penetrating injury and the related haemorrhagic shock resuscitation practice in a South African emergency medical service. Methods A prospective, observational, descriptive study was conducted in urban Cape Town. ‘R’ statistical computing was used. Emergency care providers voluntarily documented parameters for mechanism of injury, vital signs, intravenous fluid resuscitation and demographic information for patients with penetrating injury. Results Of 2884 (N) penetrating trauma cases, 143 (n) cases were sampled from providers. The chest (35.7%) and upper-limbs (31.5%) were the most common anatomy for penetrating injuries. The estimated mean crystalloid fluid volume administered for penetrating abdominal and chest injuries was 1010.6 mL and 925.3 mL respectively. A statistically significant association was observed between fluid administration and clinical indications such as systolic and diastolic blood pressure, heart rate, capillary refill time, level of consciousness estimation from the scene of the incident to the hospital after intravenous fluid administration. Most emergency medical service call outs (56%) were likely to occur between 20:00 and 02:00. Conclusion The intravenous fluid management by pre-hospital emergency care providers for patients with penetrating traumatic injuries, do not cohere with hypotensive resuscitative recommendations. Future research must include clinical practice guideline implementation efficacy and pre-hospital surveillance mechanisms. This study informs hospital clinician expectations for penetrating trauma care by pre-hospital providers.