Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality

• Published in: BMC emergency medicine Vol. 21; no. 1; p. 116
• Main Authors: Budema, Paul Munguakonkwa, Murhega, Roméo Bujiriri, Tshimbombu, Tshibambe Nathanael, Toha, Georges Kuyigwa, Cikomola, Fabrice Gulimwentuga, Mudekereza, Paterne Safari, Mubenga, Léon-Emmanuel, Maheshe-Balemba, Ghislain, Badesire, Darck Cubaka, Kanmounye, Ulrick Sidney
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-10-2021; BioMed Central; BMC
• Subjects: Adult; Analysis; Anemia; Barriers to care; Blood pressure; Chi-square test; Cohort analysis; Cohort Studies; Conflict; Congo (Kinshasa); Democratic Republic of Congo; Democratic Republic of the Congo - epidemiology; Emergency medical care; Emergency medical services; Female; Firearm injury; Firearms; Fractures; Health aspects; Hemoglobin; Hospitalization; Hospitals; Humans; Injuries; Length of stay; Limbs; Male; Medical research; Medicine, Experimental; Mortality; Patients; Regression analysis; Retrospective Studies; Statistical analysis; Statistical tests; Survival; Trauma; Trauma care; Wounds, Gunshot; Democratic Republic of the Congo; Congo (Kinshasa); Barriers to care; Firearm injury; Conflict; Survival; Democratic Republic of Congo
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/s12873-021-00506-3

The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system's resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients.
We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant.
This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO
(P < 0.001), and hemoglobin concentration (P = 0.002).
F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.