Trauma in the intellectually impaired

Abstract

Background: Individuals with intellectual disability (ID) are a uniquely vulnerable subset of South Africa’s trauma population, yet their injury patterns and outcomes remain poorly documented. This study aims to describe the epidemiology, mechanisms, and outcomes of trauma in this population.

Methods: A retrospective review was conducted at the Pietermaritzburg Metropolitan Trauma Service between December 2012 and December 2023. Patients with a documented diagnosis of ID were identified from the Hybrid Electronic Medical Registry. Demographic data, injury characteristics, management, and outcomes were analysed. Subgroup analysis compared intentional and unintentional injuries.

Results: Seventy-one patients with ID sustained trauma over the study period (0.4% of all admissions). The mean age was 25 years; 24% were female. Blunt trauma accounted for 90% of cases. Falls (27%) and pedestrian injuries (22%) were the most common mechanisms. Intentional trauma accounted for 21%, including gunshot (6%) and stab wounds (4%). The head was the most frequently injured region (77%). Morbidity was 51%, with neurological complications predominating. Admission to the intensive care unit (ICU) was required in 13%, and mortality was (1/71) 1.4%. Patients with intentional trauma were significantly older (mean 38 vs 21 years; p = 0.003).

Conclusions: Patients with ID are highly vulnerable to trauma, particularly involving the head. Although falls are the predominant mechanism in our environment, a significant proportion of patients are victims of intentional trauma.