Blows and Voluntary Wounds of the Emergency Unite in Gabriel Toure Teaching Hospital in Bamako

Introduction: Voluntary assault and injuries are acts that damage the physical and psychological integrity of a human being. WHO in its global report on violence and health estimates that in 2000, 1.6 million people worldwide died as a result of self-harm, interpersonal or collective violence, resulting in an overall rate adjusted by age of 28.8 per 100,000 population. Because of the seriousness of this phenomenon and the heavy socio-economic and health consequences that they generate, it seemed important to us to undertake this study, which aimed to study the deliberate injuries in the emergency unite of the Gabriel Touré Teaching Hospital in Bamako. Material and methods: This was a descriptive and cross-sectional study with a prospective study from September 1st, 2016 to August 31st, 12 months, covering 295 patients, including any patient received for voluntary injury consultation with a workable medical record and/or a full investigation record with or without requisition. Our data were collected on individual survey cards and subsequently analyzed with Word, Excel, IBM SPSS Statistics 22 software. Results: The majority of victims of assault and bodily injury were male with 83.1%; with a sex ratio of 4.9, the 18 to 28 age group was the most concerned with 163 cases of the 295 cases in our study, 55.2%. The extremes were 6 and 100 years old with an ectype at 11.08. The most affected ethnic group was Bambara with How to cite this paper: Moustapha, M., Madane, D.T., Hamidou, A.A., Soumaila, K., Seydou, D.A., Sogoba, Y., Madiassa, K., Siriman, K., Amadou, T., Amadou, I., Siaka, B., Kanté, A., Sadio, D., Harouna, S., Tientigui, D.B., Adegné, T. and Mahamane, D.D. (2018) Blows and Voluntary Wounds of the Emergency Unite in Gabriel Toure Teaching Hospital in Bamako. Surgical Science, 9, 334-343. https://doi.org/10.4236/ss.2018.99040 Received: August 11, 2018 Accepted: September 25, 2018 Published: September 28, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
The voluntary aggravated assault aims at the acts which undermine the physical and psychological integrity of a human being.They are known as volunteers when their author had the will to make a violent act, responsible for all the traumatic consequences, including those which it did not wish CEs traumatisms represent a real problem of public health in the countries little secured by Africa where they are associated many factors such as poverty, unsuited town planning, the lack of the qualified and justified labour [1].It is a rapid movement at the end of which a body comes to strike another body [2].Injury is an accidental or deliberate injury to a living organism following a stroke, shock, burn, using a weapon, a sharp or blunt instrument [3].WHO in its Global Report on Violence and Health estimates that in 2000, 1.6 million people worldwide died from self-harm interpersonal or collective, giving an overall age-adjusted rate of 28.8 per 100,000 population [4].WHO in 2001 estimated that 1 million people were intentionally killed each year worldwide [5].They constitute the second cause of admission after the accidents of the public highway to the service of the surgical urgencies of the hospital Gabriel Touré according to Kanikomo D et al. [6].Because of gravity of this phenomenon and heavy socio-economic and medical consequences that they generate, it appeared significant to us to undertake this study on the CBV with the SAU.The objective was to study the CBV in the service of reception of the urgencies of the CHU Gabriel Touré of Bamako.

Material and Methods
It was about a study descriptive, transverse and prospective energy of September , the clinical variables, circumstances of occurred, mechanism, the etiology, the types of lesions, the quality of the expert, the date and the hour of the examination, the commemorative ones, the complaints of the victim, the medico-surgical antecedents likely to interfere with the consequences of undergone violences or to inform about a state of vulnerability the examinations paraclinic, the diagnosis, the treatment and the evolution.Our data were collected on cards of investigation individual and analyzed thereafter with software Word, Excel, IBM SPSS Statistics 22. On the ethical level, the informed consent of the patents was approached after a careful explanation of the type of study.

Results
During our period of study we recorded 295 victims of voluntary aggravated assault.The men were more victims of the CBV in 83.1% with a sex-ratio = 4.9.
The age bracket from 18 to 28 years was most concerned with 163 cases out of the 295 cases of our study, that is to say 55.2.The extremes were 6 and 100 years with an ectype with 11.08.The ethnos group bambara will epresent with 38.6% (n = 114) followed peuls 15.6% (n = 46).The pupils and the students were touched the 24.7% (n = 73), followed tradesmen 10%.We recorded more patients coming out of the town of Bamako 22, 4% (n = 66), then commune VI = 15.6% (n = 46).The arguments with unknown were the circumstances most prevalent 30.5% (n = 90) (Table 1).Followed steerings 23.4% (n = 69).The month most concerned was that of February 14.6% (n = 43), apart from this month it y' had a constant number of victim of CBV.The mechanism was direct in 92.2% of the cases (n = 272).The most accused agents were the bayonets 51.2% (n = 151) (Table 2).Of the recorded injuries the wounds were the most frequent 53.2% of the cases.We observed a prevalence of the lesions on the level of the head with 100 cases is 33.9% (Table 3).The traumatized cranial ones were the diagnosis majority with 27.5% (n = 81).The radiography was the imagery most used with 44.7% (n = 89) followed tomodensitometry with 34.7% (n = 69).
The arguments with unknown were the most predominant circumstances  with 30.5% (n = 90) followed by robberies with 23.4% (n = 69).
NB: The 38 others were victims of aggression by many types of weapons.
We observed a predominance of lesions in the head with 100 cases or 33.9%.
Noting well: The other 54 cases are patients who had multiple injury seats.

Comments and Discussion
This work was an exploratory study over twelve months of the epidemiologic aspects; clinical of the voluntary aggravated assault we recorded 295 victims of voluntary aggravated assault.These figures are far from being exhaustive taking into account the fact that the CHU Gabriel Touré does not receive all the cases of admission for aggravated assault.We did not take account of the aspects médicolégaux and psychological catch of load in the study in the sense that the CHU Gabriel Touré does not lay out of psychiatric service even less one psychologist and the aspect médicolégal (of the total disablement of work (ITT) was dealt with by neurosurgeon legist after transfer of the victim of the urgencies towards the unit of neurosurgery.It during the following observations can be done in particular the male sex was prevalent with 83.1% is a sex/ratio with 4.9 same observation made by Mr. Dikesa, et al. [7] in its study on violence on the places of work.An Australienne study carried out by Rebecca J Mitchell [8] bearing on the intentional wounds inflicted to the children of less than 16 years shows a high proportion of hospitalization of female sex for the age bracket of 11 -16 years.On the other hand Lançon V et al. [9] answer the result of our series by the prevalent proportion of the men victims of urban violences contrary to the women mainly domestic victims of violences.The high rate of the male sex in our study would be explained by the fact that the men are more prone to cause or to defend themselves at the time of the brawls, therefore often suffer body injuries.This percentage of men victims of CBV does not mean that it y' has more men attacked in the population in general.The majority of our patients exposed to the voluntary aggravated assault was the young people, the most touched age bracket was that from 18 to 28 years, a frequency of 55.2% and one 23 years median age.This frequency is superposable with those found in other studies Ojo E et al. [10], Iram Khan Al [11], or it age bracket the most touched was that from 21 to 40 years, with a frequency of 75% and 65%.This rate could be explained by the fact why the young people are in the mediums of many brawls; what exposes them to the risks of voluntary aggravated assault.
The pupils and the students were represented in our series with 24.7%.Ojo E et al. [10], find a prevalence of the stockbreeders and the farmers accused in their series.Iram Khan Al [11], in his series, the attacker was not known victim in the majority of the cases with 47, 86%.This could be explained by the fact why the great majority of our population consists of these two most fragile layers and by the growth of violences in educational circle.The victims of CBV came primarily except Bamako with 22.4%.In the district of Bamako those are coming them from communes IV, V and II That would be explained on the one hand by a strong density of these districts, unemployment, constructions anarchistic and on the other hand owing to the fact that these districts are offset enough compared to the city in fact of the refuges for the delinquents.The arguments with unknown mainly at the time of the brawls during regroupings (estudiantins, sporting), at the market, of the political meetings or other reunion causing of the arguments were in our series the most prevalent circumstances with 30.5% follow-up of the steerings with 23.4%.The bayonets and the weapons with fire were

Figure 1 .
Figure 1.Breakdown by diagnosis and death rate.The recorded deaths were mostly related to stab wounds with 50% of cases (n = 8).

Figure 2 .
Figure 2. Distribution of patients by diagnosis and death.37.5% of deaths were caused by polytrauma.

Table 1 .
The circumstance of which has occurred.

Table 3 .
The seat of the lesion.