Prevalence, management and in-hospital outcomes of gunshot injuries at Mulago National Referral Hospital, a 5-year retrospective study

Abstract

Background: Gunshot injuries have been shown to be on the rise world over. In Africa, these are thought to be fueled by the proliferation of small arms resulting from political conflicts, as well as misuse of legal firearms due to widening gaps in socio-economic status. Whereas mortality statistics may be readily available, details on patient demographics, in-hospital prevalence and management outcomes of gunshot injuries in Uganda have scarcely been documented. Objective: This study aimed to determine the prevalence, surgical management, and in-hospital outcomes of gunshot injuries at Mulago National Referral Hospital in the 5-year period between January 2018 and January 2023. Methods: We conducted a retrospective cross-sectional study reviewing patient records to determine the prevalence of gunshot injuries over the 5-year period, how the patients were managed and what the in-hospital outcomes were. Patient data collected included demographic data, anatomical location of injury, surgical management undergone and in-hospital outcome, defined as length of stay, and mortality. Data collected were exported to STATA 18 and MS Excel 2016 for analysis. Mean with standard deviations were calculated for age and length of stay, while proportions were calculated for gender, management and in-hospital outcomes. Results: There were 131392 trauma admissions with 397 designated as gunshot injuries, a prevalence of 0.3%. 144 patient files were analyzed. The male to female ratio was 8:1, with an average age of 27.62 years. The overall in-hospital mortality was 0.69% and average length of stay was 10.15 days. Extremities (67.48%) and the chest (15.34%) were the most injured regions. 69.89% underwent surgical toilet and debridement with or without a secondary procedure of which the commonest were bone fixation followed by chest tube insertions. Conclusion: The prevalence of in-hospital gunshot injuries was 0.3% and young males were disproportionately affected. Lower limbs, upper limbs and the chest are the most affected. Surgical toilet and debridement was the commonest surgical procedure, followed by bone fixation. A vast majority of patients were discharged after management.