Advanced radiological investigations and findings amongst community assault victims admitted to a tertiary South African hospital

Abstract

Background: Community assault (CA) has been increasing in certain Cape Town suburbs over the past decade. There are limited CA-related imaging data.  The aim of this study was to review CA-related advanced radiological investigations and findings at a Level 1 South African Trauma Centre.

Methods: A retrospective study at Tygerberg Hospital, Cape Town, from 1 January through 30 June 2013. All advanced radiological investigations  performed on CA victims at the time of admission were retrieved and analysed by patient demographics, imaging investigations and radiological  findings.

Results: Sixty-two patients (n=62) with a median age of 25 years were included; CT brain was acquired in 90% (n=56) and was abnormal in 68% (n=42).  Craniofacial fractures were demonstrated in 60% (n=37), with involvement of the paranasal sinuses in 32% (n=20) and the base of skull in 19% (n=12).  Almost half (n=28/62; 45%) had intracranial haemorrhage, which was intra-axial in 36% (n=22/62), extra-axial in 34% (n=21/62) and both intra- and extra-  axial in 23% (n=14/62). Cerebral oedema was present in 29% (n=18/62), with herniation in 10% (n=6/62). Non-cranial CT was acquired in 52% (n=32/62), of  whom 19 (n=19/32; 59%) also underwent CT brain. CT abdomen was acquired in approximately a quarter of the cohort (n=16/62, 26%), demonstrating  abnormalities in 15 (24%). Fifteen cervical spine CTs were performed (n=15/62; 24%) demonstrating no acute bony injury.

Conclusion: We recommend a high index of suspicion for severe intracranial injury in CA victims and urgent tertiary referral of those with a depressed  level of consciousness. Prospective work is required to determine the long-term outlook for survivors.