Prehospital chest trauma management in the Western Cape of South Africa: an epidemiological and geospatial analysis

Wiese, Gerjo Van der Merwe

Prehospital chest trauma management in the Western Cape of South Africa: an epidemiological and geospatial analysis

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Division of Emergency Medicine

Faculty

Faculty of Health Sciences

Abstract

Introduction: South Africa bears an exceptionally heavy burden of interpersonal violence with the Western Cape province reporting some of the highest rates in the world. The majority of interpersonal violence causing critical injuries is of a penetrating mechanism, i.e. gunshot wounds and stab wounds. Penetrating chest trauma represents a significant cohort of interpersonal violence cases and poses unique challenges to the pre- and in-hospital emergency care networks of South Africa. While this injury pattern has been described from an in-hospital perspective, little is known about the prehospital phase of care of these vulnerable patients. Aim: To describe the epidemiology, emergency management and geospatial distribution of penetrating chest trauma patients in the prehospital environment of the Western Cape of South Africa. Methods: A retrospective folder review was performed of all penetrating chest trauma patients attended to by the Western Cape Department of Health and Wellness Emergency Medical Services during the period 1 January 2023 to 31 December 2023, not including interfacility transfers. Statistical analyses were performed on demographic, clinical, management, transport and geo-temporal information. Data were subjected to the non-parametric Kruskal-Wallis test, Chi-square goodness-of-fit test and Chi-square test of independence. Geospatial data were analysed using Anslin Moran's I and Getis Ord Gi* statistical tests. Results: A total of 4193 cases of penetrating chest trauma were identified and analysed. A strong male preponderance was found (n=3658, 87.25%) with a mean age of 30.82 years (standard deviation=10.06). The predominant mechanism of injury was found to be stab wounds (n=3930, 93.73%) followed by gunshot wounds (n=263, 6.27%). It was found that male patients were at higher odds of being shot than females (odds ratio (OR): 1.90, 95% confidence interval (CI): 1.18–3.06, p=0.007) and patients who were shot were significantly more likely to be triaged as Orange (OR: 1.92, 95% CI: 1.46 to 2.5), Red (OR: 4.68, 95% CI: 3.45 to 6.35) or Blue (OR: 23.06, 95% CI: 16.10 to 33.00) compared to patients who were stabbed. Consistent with international literature related to interpersonal violence, penetrating chest trauma was more common at night (p<0.001) and over weekends (p<0.001) and least common during winter months (p<0.001). High acuity patients (triage categories Orange and Red) comprised 30.29% (n=1262) of this study sample while ambulance emergency assistant-level practitioners were the highest qualified in the majority of high acuity cases (n=666, 52.77%). Median scene time intervals were statistically significantly different between patient triage categories (p<0.001) with a trend towards increased scene time intervals as patient acuity increased. Previously unreported penetrating chest trauma hot spots (99% confidence) were identified in the northern area of the Cape Town metropole as well as the Cape Winelands and Overberg districts of the Western Cape province. Conclusion: Interpersonal violence and penetrating chest trauma remain prevalent throughout the Western Cape of South Africa and impose a significant burden on public prehospital resources and healthcare facilities. The study findings highlight geographic areas in need of targeted public safety interventions as well as strengthening of emergency care networks. In the absence of resource-intensive interventions, such as prehospital ultrasound and intercostal drain insertion seen in high-income countries, the ‘stay and play' paradigm observed in this study may not be in these patients' best interests. Further research is warranted to determine optimal prehospital management strategies of penetrating chest trauma patients, tailored to the unique South African emergency care landscape.

Keywords

chest trauma

emergency medecine

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