Shotgun injuries – Analysis of 148 patients managed at a major trauma centre in South Africa

Abstract

Background The aim of this study was to review the spectrum, pattern and clinical outcome of shotgun injuries managed at a major trauma centre with limited resources. Methods Patients presenting with shotgun injuries between January 2012 and December 2024 were retrospectively reviewed. This was accomplished using the Hybrid Electronic Medical Registry. Data included demographics, injury pattern, regions affected, diagnostic imaging, operative interventions and clinical outcomes. Results During the 13-year study period, a total of 148 patients sustained shotgun injuries. The median age was 31 years and 93% (137/148) were male. The median Injury Severity Score was 9. Of the 148 patients, 76% (112/148) had plain films performed in the resuscitation room, and 76% (113/148) underwent computed tomography following initial assessment. Single body injuries were noted in around half (51%) of the patients, with the remaining sustaining injuries in multiple regions. The abdomen was most commonly injured (46%), followed by the chest (38%) and lower limb (34%). Operative intervention was necessary for 88 patients (59%), of whom 33 (38%) required multiple operations. The median total length of hospital stay was 5 days, with an overall mortality rate of 5% (8/148). Conclusion Shotgun injuries are associated with a range of injuries to multiple body regions. These injuries have a high requirement for operative intervention and pose a significant morbidity and mortality risk. High-quality imaging is essential but must be integrated with clinical assessment to guide management.