Gunshot injuries in infants and children in KwaZulu-Natal--an emerging epidemic?

OBJECTIVES

To determine the pattern of firearm injuries in children under the age of 13 years admitted to a paediatric surgical unit in KwaZulu-Natal and to assess the impact of such injuries on hospital resources.

DESIGN

Retrospective review of the Department of Paediatric Surgery and hospital databases for all gunshot admissions, 1983-1995 inclusive.

SETTING

King Edward VIII Hospital, Durban.

SUBJECTS

Children aged 12 years and under admitted to the care of the Department of Paediatric Surgery for management of gunshot injuries.

METHODS

Data retrieved included demographic details, circumstances of injury, duration of hospital stay, management and outcome in terms of mortality and long-term morbidity.

RESULTS

One hundred and six patients were identified, of whom 96 were available for review. There has been a rapid escalation of numbers presenting. During 1994-1995, an additional 38 children with gunshot injuries were admitted to other units within Durban academic hospitals. The mean age of injury in patients admitted to the Department of Paediatric Surgery was 6.4 years and the abdomen was the most frequently injured area. Multiple injuries were common. The in-hospital mortality rate was 10.4%. Major morbidity, including paraplegia, hemiplegia, amputation and major peripheral nerve deficit, was seen in 11.4%. Duration of bed occupancy in the general surgical ward reached 247 days in 1995.

CONCLUSION

There is an increasing incidence of gunshot injuries in this region. Of children surviving to reach hospital, 10% die and 11% are left with lifelong major morbidity. Most victims are innocent bystanders and too young to be considered active participants. Prevention will require sociopolitical stability and the disarming of the community.