Association between community assault and adverse renal outcomes among patients with crush injury in South Africa: a retrospective cohort study

Abstract

Background Civilians in South Africa experience a high incidence of crush injury, or traumatic rhabdomyolysis. Community assault (CA) is a common mechanism of crush injury in South Africa, where victims are assaulted by multiple persons using a variety of objects. A crush injury places patients at risk of renal dysfunction. The study objective is to evaluate the association between CA and adverse renal outcomes (AROs) among patients with crush injury. Methods In this secondary analysis of abstracted medical records, we examined clinical data from adult crush patients who presented to one of six trauma centres in the Western Cape Province of South Africa from September 2021 to December 2023. ARO was defined as potassium >6mEq/L, creatinine >4mg/dL, initiation of dialysis or death due to renal failure. We used multivariable logistic regression to evaluate the association between CA and ARO. Results Of 976 crush patients (mean age 32 years, 89% male), half were victims of CA (n=464, 48%). 4% of the overall cohort had ARO, but less than 1% (n=7) received dialysis. More patients with CA developed ARO (n=27, 6%) compared with patients without CA (n=15, 3%) (unadjusted p=0.03). In-hospital all-cause mortality was not significantly different between CA and non-CA (8% vs 7%, p=0.58). After adjusting for age, sex, systolic blood pressure and injury severity, patients with CA had 2.42 times the odds of ARO than patients without CA (95%CI 1.20 to 4.85, p=0.01). Conclusion This study suggests that CA is an independent risk factor for AROs among patients with crush injury in South Africa. Victims of CA with renal dysfunction require aggressive resuscitation and may warrant early transfer to tertiary care centres.