Analysis of emergency centre recidivism for interpersonal violence in a district-level hospital in Cape Town, South Africa
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i11.2373Keywords:
Interpersonal violence, Recidivism, Emergency Medicine, Injury, gender-based violenceAbstract
Background. Interpersonal violence is a major cause of morbidity and mortality in low- and upper-middle-income countries. It is postulated that a significant portion of these patients have repeated presentations to an already overburdened healthcare system. Data describing the burden of interpersonal violence recidivism are poor.
Objective. To determine and describe the burden of emergency centre recidivism for interpersonal violent injury presenting to Khayelitsha Hospital, Cape Town, over a 2-year period.
Methods. An analysis of a prospectively collected observational database combined with a retrospective chart review was conducted of all trauma patients who presented to Khayelitsha Hospital from 1 October 2020 to 30 September 2022. All patients (aged ≥14 years) with ≥2 presentations for interpersonal violence-related injuries were included. Cases were limited to the inclusion of mechanisms of injury attributable to stab wounds, blunt assault, firearm injury and gender-based violence. Recidivist cases were identified by repeat hospital number on the electronic hospital patient system. Repeat cases were manually reviewed for inclusion. Summary statistics are used to describe all variables.
Results. In total, 10 218 interpersonal violence presentations were identified over the study period, and 1 125 (11.0%) were attributed to recidivists (522 patients). The mean (standard deviation) age was 30 (7.7) years, and most were male (n=463, 88.7%). Stab wounds (n=583, 51.8%) and blunt assault injuries (n=456, 40.5%) were the main mechanisms of injury. Repeat presentation occurred within a median of 198 (25th - 75th percentile, 81.5 - 373.9) days. A total of 337 (64.6%) patients presented with higher acuity at one of their subsequent visits.
Conclusion. Recidivist presentations represent a significant proportion of interpersonally violently injured patients, and are likely to be under-documented. Recidivism poses a measurable burden, and further research is needed to facilitate the identification of at-risk individuals, and specific secondary prevention strategies should be developed to prevent or reduce escalating patterns of injury associated with interpersonal violence.
References
1. World Health Organization. Global health estimates 2019: Deaths by cause, age, sex, by country and by region, 2000 - 2019. Geneva: WHO, 2020. https://www.who.int/data/gho/data/ themes/mortality-and-global-health-estimates/ghe-leading- causes-of-death (accessed 30 June 2024).
2. Mercy JA, Hillis SD, Butchart A, et al. Interpersonal violence: Global impact and paths to prevention. In: Mock CE, Nugent R, Kobusingye O, et al. Injury Prevention and Environmental Health, 3rd ed. International Bank for Reconstruction and Development/World Bank, 27 October 2017. https://doi. org/10.1596/978-1-4648-0522-6_ch5
3. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet 2002;360(9339):1083-1088. https:// doi.org/10.1016/s0140-6736(02)11133-0
4. BusinessTech. Cape Town, Joburg, Durban and Gqeberha among the most violent cities in the world. BusinessTech, 21 March 2022. https://businesstech.co.za/news/trending/569222/ cape-town-joburg-durban-and-gqeberha-among-the-most- violent-cities-in-the-world/ (accessed 30 June 2024).
5. South African Police Service. Annual Crime Statistics 2021/2022. SAPS, 2022. https://www.saps.gov.za/services/ downloads/Annual-Crime-2021_2022-web.pdf (accessed 30 June 2024).
6. Western Cape Government, Department of Community Safety. Western Cape Crime Trends 2021/22. Western Cape Government, 2022. https://www.westerncape.gov.za/sites/www. westerncape.gov.za/files/wc_crime_analysis_report_final.pdf (accessed 30 June 2024).
7. Mitra A, Okafor UB, Kaswa R, Adeniyi OV. Epidemiology of interpersonal violence at a regional hospital emergency unit in the Eastern Cape, South Africa. S Afr Family Prac 2022;64(1 Part 2):a5511. https://doi.org/10.4102/safp.v64i1.5511
8. Leeper S, Lahri S, Myers J, et al. Assault-injured youth in the emergency centres of Khayelitsha, South Africa: Baseline characteristics and opportunities for intervention. Injury 2019;50(12):2220-2227. https://doi.org/10.1016/j. injury.2019.10.014
10. Nicol A, Knowlton LM, Schuurman N, et al. Trauma surveillance in Cape Town, South Africa. JAMA Surg 2014;149(6):549. https://doi.org/10.1001/jamasurg.2013.5267
11. Bush L, Hendrikse C, van Koningsbruggen C, Evans K. The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis. S Afr Med J 2024;114(2):e1176. https://doi.org/10.7196/samj.2024.v114i2.1176
12. Kaminer D, du Plessis B, Hardy A, Benjamin A. Exposure to violence across multiple sites among young South African adolescents. J Peace Psychol 2013;19(2):112-124. https://doi.org/10.1037/a0032487
13. Fazel S, Smith EN, Chang Z, Geddes JR. Risk factors for interpersonal violence: An umbrella review of meta-analyses. Br J Psychiatry 2018;213(4):609-614. https://doi.org/10.1192/bjp.2018.145
14. McLaughlin KA, Koenen KC, Hill ED, et al. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolescent Psychiatr 2013;52(8):815-830.e14. https:// doi.org/10.1016/j.jaac.2013.05.011
15. Wiener CD, Moreira FP, Zago A, et al. Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: A population-based study. Revista Brasileira de Psiquiatria 2017;40(1):1-5. https://doi.org/10.1590/1516-4446-2016-2170
16. Norman R, Schneider M, Bradshaw D, et al. Interpersonal violence: An important risk factor for disease and injury in South Africa. Pop Health Metrics 2010;8(1):32. https://doi.org/10.1186/1478- 7954-8-32
17. Prinsloo M, Machisa M, Kassanjee R, et al. Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012. S Afr Med J 2022;693-704. https://doi. org/10.7196/samj.2022.v112i8b.16512
18. Institute for Economics and Peace. Global Peace Index 2024: Measuring peace in a complex world. Sydney: IEP, June 2024. http://visionofhumanity.org/resources (accessed 28 June 2024).
19. Leeper SC, Patel MD, Lahri S, et al. Assault-injured youth in the emergency centres of Khayelitsha, South Africa: A prospective study of recidivism and mortality. Afr J Emerg Med 2021;11(4):379-384. https://doi.org/10.1016/j.afjem.2021.07.001
20. Norman R. The high burden of injuries in South Africa. Bull World Health Org 2007;85(09):695-702.
https://doi.org/10.2471/blt.06.037184
21. Bola S, Dash I, Naidoo M, Aldous C. Interpersonal violence: Quantifying the burden of injury in a South African trauma centre. Emerg Med J 2015;33(3):208-212. https://doi.org/10.1136/ emermed-2014-204160
22. Western Cape Government. Eco-friendly Khayelitsha Hospital 2019. https://www.westerncape.gov.za/ department-of-infrastructure/eco-friendly-khayelitsha-hospital (accessed 28 June 2024).
23. Garone DB, Hilderbrand K, Boulle AM, et al. Khayelitsha 2001 - 2011: 10 years of primary care HIV and TB programmes. South Afr J HIV Med 2011;12(4):33. https://doi.org/10.4102/sajhivmed.v12i4.170
24. Hunter LD, Lahri S, van Hoving DJ. Case mix of patients managed in the resuscitation area of a district-
level public hospital in Cape Town. Afr J Emerg Med 2017;7(1):19-23. https://doi.org/10.1016/j.
afjem.2017.01.001
25. South African Triage Group. The South African Triage Scale (SATS) 2019. https://emssa.org.za/special-
interest-groups/the-south-african-triage-scale-sats/ (accessed 28 June 2024).
26. Magruder KM, McLaughlin KA, Elmore Borbon DL. Trauma is a public health issue. Euro J
Psychotraumatol 2017;8(1):1375338. https://doi.org/10.1080/20008198.2017.1375338
27. Perkonigg A, Kessler RC, Storz S, Wittchen H. Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica
2000;101(1):46-59. https://doi.org/10.1034/j.1600-0447.2000.101001046.x
28. Hoosen P, Adams S, Tiliouine H, Savahl S. Youth and adolescents’ perceptions of violence in post-
apartheid South Africa: A systematic review of the literature. Child Indicators Res 2022;15(3):885-911.
https://doi.org/10.1007/s12187-021-09890-5
29. Harris G, Vermaak C. Economic inequality as a source of interpersonal violence: Evidence from sub- Saharan Africa and South Africa. S Afr J Econo Manage Sci 2015;18(1):45-57. https://doi.org/10.4102/ sajems.v18i1.782
30. Kaufmann CR, Branas CC, Brawley ML. A population-based study of trauma recidivism. J Trauma 1998;45(2):325-332. https://doi.org/10.1097/00005373-199808000-00019
31. Nygaard RM, Marek AP, Daly SR, Van Camp JM. Violent trauma recidivism: Does all violence escalate? Euro J Trauma Emerg Surg 2017;44(6):851-858. https://doi.org/10.1007/s00068-017-0787-5
32. Statistics South Africa. Unemployment in South Africa: A youth perspective. Pretoria: Stats SA, 2024. https://www.statssa.gov.za/?p=17266 (accessed 22 August 2024).
33. Outwater AH, Mgaya E, Msemo S, Helgesson L, Abraham AG. Youth unemployment, community violence, creating opportunities in Dar es Salaam, Tanzania: A qualitative study. Tanzania J Health Res 2015;17(1). https://www.ajol.info/index.php/thrb/article/download/104128/100996 (accessed 22 August 2024).
34. Tshabalala NG. Crime and unemployment in South Africa; revisiting an established causality: Evidence from the KwaZulu-Natal Province. Mediterranean J Soc Sci 2014;5(15):519. https://doi. org/10.5901/mjss.2014.v5n15p519
35. Zungu LT, Mtshengu TR. The twin impacts of income inequality and unemployment on murder crime in African emerging economies: A mixed models approach. Economies 2023;11(2):58. https://doi. org/10.3390/economies11020058
36. Fitterer JL, Nelson TA, Stockwell T. A review of existing studies reporting the negative effects of alcohol access and positive effects of alcohol control policies on interpersonal violence. Front Public Health 2015;3. https://doi.org/10.3389/fpubh.2015.00253
37. World Health Organization. Global status report on alcohol and health 2018. Geneva: WHO, 2018. https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf ?ua=1 (accessed 28 June 2024).
38. Govender I, Matzopoulos R, Makanga P, Corrigall J. Piloting a trauma surveillance tool for primary healthcare emergency centres. S Afr Med J 2012;102(5):303. https://doi.org/10.7196/samj.5293
39. Van Hoving DJ, van Koningsbruggen C, de Man M, Hendrikse C. Temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Afr J Emerg Med 2021;11(4):477-482. https://doi.org/10.1016/j.afjem.2021.08.001
40. Bachan V, Molefe I, Davies B. Investigating blood alcohol concentrations in injury-related deaths before and during the COVID-19 national lockdown in Western Cape, South Africa: A cross-sectional retrospective review. S Afr Med J 2023;113(6):50-56. https://doi.org/10.7196/samj.2023.v113i6.372
41. Caufeild J, Singhal A, Moulton R, Brenneman F, Redelmeier D, Baker AJ. Trauma recidivism in a large urban Canadian population. J Trauma 2004;57(4):872-876. https://doi.org/10.1097/01. ta.0000135350.06670.60
42. Brooke BS, Efron DT, Chang DC, Haut ER, Cornwell EE. Patterns and outcomes among penetrating trauma recidivists: It only gets worse. J Trauma 2006;61(1):16-20. https://doi.org/10.1097/01. ta.0000224143.15498.bb
43. Wood D, Rosedale K. Crush syndrome in the rural setting. Emerg Med J 2011;28(9):817. https://doi. org/10.1136/emj.2010.104208
44. Smith WA, Hardcastle TC. A crushing experience: The spectrum and outcome of soft tissue injury and myonephropathic syndrome at an urban South African university hospital. African J Emerg Med 2011;1(1):17-24. https://doi.org/10.1016/j.afjem.2011.04.002
45. Seedat M, van Niekerk A, Jewkes R, Suffla S, Ratele K. Violence and injuries in South Africa: Prioritising an agenda for prevention. Lancet 2009;374(9694):1011-1022. https://doi.org/10.1016/ s0140-6736(09)60948-x
46. World Health Organization. Violence prevention: The evidence. Geneva: WHO, 2010. https://www. who.int/publications/i/item/violence-prevention-the-evidence (accessed 30 June 2024).
Downloads
Published
Issue
Section
License
Copyright (c) 2024 J J Horn, L Bush, D J van Hoving
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.