The Burden of Paediatric Trauma in Pietermaritzburg

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A study by UKZN Masters in Medicine (Surgery) student, Dr Vassil Manchev, has found the burden of paediatric trauma in the Pietermaritzburg CBD and the Western rural health districts to be significantly high enough to warrant a public health intervention.

Manchev’s study is based on data from an Electronic Surgical Registry (ESR) implemented as part of a quality improvement programme by the Pietermaritzburg Metropolitan Trauma Service (PMTS) which upgraded the system to a comprehensive hybrid electronic medical registry (HEMR) in January 2013 at Grey’s Hospital.

The data from the ESR and the HEMR was used in the study to establish the incidence, spectrum and outcome of paediatric trauma managed by the PMTS.

Between January 2012 and June 2014, 1041 patients under the age of 18 were managed by the PMTS. The average age of patients was 10.9 years and included 724 male and 317 female patients. Blunt trauma accounted for 72.3% (753 patients) of injuries and penetrating trauma 16.3% (170 patients).

Blunt trauma is defined as a serious injury caused by a blunt object or collision with a blunt surface and usually results in physical trauma to a body part, either by impact, injury or physical attack.

In the study, Manchev found that of the 753 patients presenting with blunt trauma injuries, 219 were as a result of a pedestrian vehicle collision, 136 due to assault, 113 due to a motor vehicle collision, 231 to various falls, 21 a result of community assault, 14 hangings, 17 to either a sport or animal injury, while one was self-inflicted and one due to an explosion.

Manchev said: ‘Trauma is the leading cause of childhood deaths in low and middle-income countries hence it is a major public health problem and our data supports this contention.

‘One of the reasons for this, as our study indicates, is that blunt trauma can be attributed to the ongoing urbanisation and increased levels of motorisation in South Africa which is likely to result in growing rates of road traffic collisions. Another distinguishing characteristic of our experiences is the excessively high incidence of intentional trauma which has been reported in major centres in South Africa.’

The study found that the operative workload for paediatric trauma in the PMTS was significant. Further, if surgery was required, multiple interventions were usually necessary, placing a huge burden on the PMTS. Statistics have indicated that 315 patients required a total of  1179 operative interventions, equating to an average of 3.7 operative interventions for each patient who required an operation.

With road traffic incidents (RTCs) remaining the leading cause of blunt injuries in South Africa, the researchers suggested three primary interventions to prevent and reduce RTCs - safety engineering, education and legislation.

They found that some risk factors could be addressed by improving playground, sports and vehicle safety as well as through the introduction of traffic calming zones around schools and public places.

By using the ESR and HEMR, the researchers were able to produce a detailed overview of the problem and the outcome of trauma in children in Pietermaritzburg.

The researchers also found that the burden of disease was significant, and there was a high incidence of intentional trauma and penetrating trauma in the area.

‘The study proves the importance of injury prevention programmes in the city of Pietermaritzburg,’ said Manchev. ‘This warrants a dedicated paediatric trauma centre. Furthermore, our study has indicated that attention must be given to improving pre-hospital services.’

•   Manchev, a registrar in surgery in Pietermaritzburg, is writing his final surgical fellowship examination in September after which he hopes to play an integral role in the ongoing development of a trauma service in Pietermaritzburg.  He is supervised by Dr Damian Clarke, president of the Surgical Research Society of Southern Africa and Lead Trauma Surgeon and Academic Head of the Area 2 Trauma Service in the Pietermaritzburg Metropolitan area.

MaryAnn Francis