Association Between Sjambok Injuries and Renal Dysfunction Examined in PhD Research

By | November 16, 2018
Dr David Skinner.

The relationship between injuries caused by being hit with a sjambok and renal dysfunction was examined in a paper by University of KwaZulu-Natal doctoral candidate, Dr David Skinner.

The paper titled: “Validating the Utilisation of Venous Bicarbonate as a Predictor of Acute Kidney Injury in Crush Syndrome from Sjambok Injuries”, has been published in the South African Medical Journal (SAMJ).

Skinner from UKZN’s Discipline of Anaesthesiology works in the Intensive Care Unit at King Edward Hospital in Durban looking after medical, surgical and obstetric patients who are critically ill and require life support.

Research by Skinner and his team who worked with 310 patients in their study, revealed that utilisation of the low cost biochemical test venous bicarbonate strongly correlated with the need for dialysis thus allowing practitioners to use the presenting venous bicarbonate to risk stratify sjambok patients on admission. This guided resuscitation and monitoring if patients were at high risk of developing renal failure enabling them to be referred early for dialysis, which can be a life-saving intervention.

Skinner said he had worked closely with Professor David Muckart at UKZN’s Department of Surgery who had done a lot of work on sjambok injuries in South Africa in the 1990s.

‘Professor Muckart, who was my mentor, inspired me to look more closely at this phenomenon and explore the relationships between community assault/sjambok injuries and renal dysfunction.’

Skinner also worked closely with colleague Dr Grant Laing, who encouraged him to explore and validate the initial studies done by Muckart in risk stratification of patients presenting with sjambok injuries. The analysis was retrospective and classified the patients according to modern acute kidney injury risk stratification classifications and compared that to their presentation biochemistry and outcomes of renal dysfunction/failure, dialysis and mortality.

Although this is not the first study of its kind, it validates Muckart’s findings from his original study, with a large cohort of patients. It is unique in that it describes one of the largest series of patients with crush syndrome from sjambok/assault injuries.

Skinner aims to publicise the validated risk stratification model proposed in the paper.  He says the model can be used by clinicians in emergency medicine, surgery and other medical disciplines where patients with these injuries are encountered. Early recognition of the severity of such injuries would hopefully decrease mortality and the complication of renal dysfunction in the patients.

Skinner, who is being supervised by Professor Bruce Biccard, said the paper was his first towards his PhD project: “Acute Kidney Injury and Crush Syndrome: Epidemiology, Renal Replacement Therapy and Outcomes Among Surgical and Critically Ill Patients in a Resource Constrained Setting”.

Skinner studied for his undergraduate degree at the former University of Natal, and his postgraduate MMed degree through UKZN before going on to obtain his specialist and sub-specialist qualifications at the College of Medicines (South Africa).

‘I believe that research should be used to benefit society as a whole and that the work we are doing can have a positive impact on South African healthcare,’ he said.

Lihle Sosibo

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