Bowley Douglas M G, Khavandi Ali, Boffard Kenneth D, Macnab Cara, Eales Jocelyn, Vellema Jeanine, Schoön Heloïse, Goosen Jacques
Johannesburg Hospital Trauma Unit, Department of Surgery, University of the Witwatersrand.
S Afr Med J. 2002 Oct;92(10):798-802.
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.
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.
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.
创伤在全球造成的负担日益加重，但在各国之间分布不均。南非的创伤主要影响社会中的年轻人和有生产力的人群，并给卫生基础设施带来了沉重负担。我们对约翰内斯堡医院创伤科（JHTU）和约翰内斯堡法医学实验室（JMLL）收治患者的损伤趋势进行了回顾，以记录在17年的重大社会和政治变革期间创伤模式的演变。
设计、研究对象与观察指标：这是一项对1985年1月至2001年12月期间在JHTU就诊的所有一级优先患者的回顾性研究。利用JHTU创伤数据库检索患者人口统计学信息、伤口机制和损伤严重程度。对自1996年以来维护的JMLL数据库进行了检查，并分析了死亡方式和地点。
在过去17年中，JHTU的创伤患者数量出现了前所未有的增长。患者的人口统计学特征发生了变化，目前损伤主要是由于人际暴力所致。自1996年以来，JMLL检查的非自然死亡人数下降了19%；然而，因枪伤导致的死亡比例有所上升。
近年来南非的社会和政治变革导致了JHTU所见损伤特征的变化。部分增长可以通过种族隔离的消除和当地医院服务提供的减少来解释；然而，南非城市化、跨境移民和药物滥用高发的影响也得到了认可。有证据支持实施立法、环境、社会和行为干预措施，以控制和减少暴力与损伤的发生率及影响。必须在各级共同努力遏制南非的创伤流行。
