GUNSHOT INJURIES IN INFANTS AND CHILDREN IN KWAZULU-NATAL - AN EMERGING EPIDEMIC

Objectives. To determine the pattern of firearm injuries in children u nder the age of 13 years admitted to a paediatric surgical unit in Kwa Zulu-Natal and to assess the impact of such injuries on hospital resou rces. Design. Retrospective review of the Department of Paediatric Sur gery and hospital databases for all gunshot admissions, 1983 - 1995 in clusive. Setting, King Edward VIII Hospital, Durban. Subjects. Childre n aged 12 years and under admitted to the care of the Department of Pa ediatric Surgery for management of gunshot injuries. Methods. Data ret rieved included demographic details, circumstances of injury, duration of hospital stay, management and outcome in terms of mortality and lo ng-term morbidity. Results. One hundred and six patients were identifi ed, of whom 96 were available for review, There has been a rapid escal ation of numbers presenting. During 1994 - 1995, an additional 38 chil dren 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 th e most frequently injured area, Multiple injuries were common, The in- hospital mortality rate was 10.4%. Major morbidity, including parapleg ia, hemiplegia, amputation and major peripheral nerve deficit, was see n in 11.4%. Duration of bed occupancy in the general surgical ward rea ched 247 days in 1995, Conclusion. There is an increasing incidence of gunshot injuries in this region, Of children surviving to reach hospi tal, 10% die and 11% are left with lifelong major morbidity, Most vict ims are innocent bystanders and too young to be considered active part icipants, Prevention will require sociopolitical stability and the dis arming of the community.