Journal of the colleges of medicine of South Africa最新文献

{"title":"Beyond accreditation: Specialist training as a strategic national asset in South Africa.","authors":"Francis E Smit, Johannes J Fagan, Zach M Koto","doi":"10.4102/jcmsa.v4i1.478","DOIUrl":"https://doi.org/10.4102/jcmsa.v4i1.478","url":null,"abstract":"","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"478"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All talk, little action: A scoping review mapping lifelong learning education strategies in postgraduate medical education.","authors":"Megan O'Connor, Antoine G L Rocher, Jennifer M Wolf, Veena Singaram, Leonard C Marais","doi":"10.4102/jcmsa.v4i1.427","DOIUrl":"10.4102/jcmsa.v4i1.427","url":null,"abstract":"<p><strong>Background: </strong>Lifelong learning (LLL) is a core competency in postgraduate medical education (PGME), yet little is known about how registrar programmes teach it. Although LLL is prominent in policy and discourse, knowledge of best-practice educational strategies during registrar training remains limited.</p><p><strong>Aim: </strong>This study aimed to map and synthesise the empirical research of strategies designed to foster LLL in registrar training.</p><p><strong>Setting: </strong>The study was carried out at postgraduate orthopaedic training institutions in South Africa.</p><p><strong>Method: </strong>A scoping review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) guidelines to identify educational strategies that promote LLL in PGME. Searches of MEDLINE, EMBASE, Web of Science, and the Cochrane Library were performed from database inception to November 2025 using medical subject headings (MeSH) terms including 'lifelong learning' and 'registrar', supplemented by reference screening. Bibliographic data were tabulated, and strategies synthesised into three overarching categories.</p><p><strong>Results: </strong>Of the 492 records screened, eight studies met the inclusion criteria. Strategies clustered into three groups: (1) goal-setting; (2) reflection, self-assessment, and feedback; and (3) evidence-based medicine (EBM) training. The vehicles for delivering these strategies included individualised learning plans, portfolios, goal-setting requirements, and EBM training courses.</p><p><strong>Conclusion: </strong>The review identified eight studies describing strategies to foster LLL in registrar training, concentrated in North America, and non-surgical disciplines. The paucity and heterogeneity of published evidence highlight the need for intentional incorporation and evaluation of the impact of LLL in postgraduate curricula across diverse contexts.</p><p><strong>Contribution: </strong>This review provides the first mapped synthesis of explicit LLL educational strategies in PGME, identifying gaps and informing future curriculum design.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"427"},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of technical factors on the chest radiographic findings in COVID-19 pneumonia.","authors":"Zukiswa Sobetwa, Stephanie Griffith-Richards, Martin Kidd, Richard D Pitcher","doi":"10.4102/jcmsa.v4i1.313","DOIUrl":"10.4102/jcmsa.v4i1.313","url":null,"abstract":"<p><strong>Background: </strong>Published coronavirus disease 2019 (COVID-19) chest X-ray (CXR) severity scoring systems do not consider the impact of technical factors on radiographic findings. This study aimed to describe the technical features of COVID-19 pneumonia CXRs, determine their impact on CXR interpretation and reappraise published COVID-19 CXR severity scoring systems based on these findings.</p><p><strong>Methods: </strong>Admission frontal CXRs of 100 consecutive adults with proven COVID-19 pneumonia were analysed for technical features (projection, inspiratory excursion, exposure, vertical rotation) and pulmonary opacification. Descriptive statistics were evaluated. Kendall's coefficient of concordance was used to assess observer agreement. One-way analysis of variance (ANOVA) was used to determine the association between technical factors and opacification. Levene's test for homogeneity-of-variance and the Welch test were conducted where applicable. For inspiratory excursion, correlations were also calculated. Findings informed a review of published COVID-19 CXR severity scoring systems.</p><p><strong>Results: </strong>Poor inspiratory excursion obscured the lower lung zones in 41 cases and was associated with increased opacification in the visible (mid and upper) zones. Under- (<i>n</i> = 13) and over-penetration (<i>n</i> = 39) were associated with increased and decreased basal opacification, respectively. Eighty cases (80%) showed vertical rotation, without significant impact on opacification. Re-appraisal of published COVID-19 CXR scoring systems revealed that all simply assessed the visible lung fields, without considering inspiration or penetration.</p><p><strong>Conclusion: </strong>Published COVID-19 CXR severity scoring systems could be refined by appropriate consideration of inspiratory excursion and penetration. More broadly, technical considerations should inform all CXR interpretation.</p><p><strong>Contribution: </strong>This study advocates incorporating technical factor assessment into CXR severity scoring systems.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"313"},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onychomycosis in KwaZulu-Natal: Clinical spectrum, risk factors and fungal susceptibility.","authors":"Jaya Jhoomuck, Yesholata Mahabeer, Antoinette Chateau","doi":"10.4102/jcmsa.v4i1.409","DOIUrl":"10.4102/jcmsa.v4i1.409","url":null,"abstract":"<p><strong>Background: </strong>Although onychomycosis is common worldwide and often significantly impairs the quality of life of patients, local epidemiological and mycological data are lacking. We therefore investigated the risk factors, clinical features and mycological aspects of onychomycosis in KwaZulu-Natal.</p><p><strong>Methods: </strong>This study had two components. In the retrospective arm, positive fungal nail cultures from 2018 to 2024 were analysed. Prospectively in 2025, clinical and mycological data were collated. Descriptive statistical methods were used to summarise the dataset.</p><p><strong>Results: </strong>Out of a total of 301 patients, 229 patients with positive cultures were analysed. The retrospective analysis (<i>n</i> = 177) showed <i>Candida</i> species were the most common (66.7%), followed by moulds (13.6%) and <i>Trichophyton</i> species (11.9%). Prospectively, 124 patients were included; 51.6% females and 48.4% males with a median age of 58.0 years. <i>Candida</i> species (40.4%), moulds and <i>Trichophyton</i> species (25.0% each) were most frequent in 52 patients with positive cultures. All <i>Candida</i> species were susceptible to fluconazole. Most patients had subungual hyperkeratinisation. Immunosuppression (other than human immunodeficiency virus [HIV] infection and diabetes mellitus) was the most common risk factor.</p><p><strong>Conclusion: </strong><i>Candida</i> species were the commonest cause of onychomycosis; therefore fluconazole is an appropriate treatment modality. However, revision of the existing essential drug list is recommended to include itraconazole or terbinafine for patients with confirmed infection with moulds or dermatophytes.</p><p><strong>Contribution: </strong>This is the first detailed analysis of onychomycosis in KwaZulu-Natal and contributes to the limited body of data in South Africa. Our results may be used to inform therapeutic recommendations.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"409"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.","authors":"Isabella M Joubert, Mozamil Mohamed, Maeyane S Moeng","doi":"10.4102/jcmsa.v4i1.422","DOIUrl":"10.4102/jcmsa.v4i1.422","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management (NOM) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (LMICs) remain scarce, particularly in settings with a high burden of penetrating trauma.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study analysed 251 adult patients with liver injuries managed non-operatively at a major trauma centre in Johannesburg, South Africa, between January 2017 and December 2023. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day survival and associated injury patterns.</p><p><strong>Results: </strong>Overall mortality was 1.20% (3/251; Wilson 95% confidence interval [CI]: 0.41-3.45). All deaths occurred within 30 days. Admission lactate was the only variable significantly associated with mortality in the univariate analysis (odds ratio [OR]: 1.53 per 1 mmol/L increase, 95% CI: 1.11-2.10, <i>p</i> = 0.009). Sensitivity analysis using Firth's penalised logistic regression yielded consistent results (penalised OR: 1.48, 95% CI: 1.08-2.03, <i>p</i> = 0.015). The American Association for the Surgery of Trauma (AAST) liver injury grade showed no association with mortality. Chest injuries were the most common associated injury (42.6%). Associated injury patterns were consistent across Grades III-V.</p><p><strong>Conclusion: </strong>In appropriately selected haemodynamically stable patients, NOM achieved excellent outcomes despite a substantial polytrauma burden. Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments.</p><p><strong>Contribution: </strong>This study provides key insights into the real-world outcomes of non-operative management (NOM) of liver trauma in a high-volume, resource-constrained South African trauma centre. It demonstrates exceptionally low mortality (1.20%) with physiology-led patient selection despite a high burden of penetrating trauma and polytrauma. The primary contribution is evidence that admission lactate is a strong predictor of mortality, while anatomic injury grade (AAST) is not. These findings reinforce physiology-guided decision-making in LMIC settings and align directly with the journal's focus on clinical practice and surgical outcomes in Southern Africa.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"422"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The coalition of the willing: A deliberate leadership strategy for reforming postgraduate emergency medicine assessment in South Africa.","authors":"Sa'ad Lahri","doi":"10.4102/jcmsa.v4i1.419","DOIUrl":"10.4102/jcmsa.v4i1.419","url":null,"abstract":"<p><p>This commentary reflects on two consecutive terms as President of the College of Emergency Medicine of South Africa and examines a deliberate leadership strategy used to reform postgraduate assessment within a voluntary professional body. At the outset, the postgraduate emergency medicine curriculum required reform, and existing assessment approaches had developed over time in ways that were not always fully aligned with evolving training goals or contemporary validity expectations. As competency-based medical education and entrustable professional activity frameworks gained traction, the need for closer alignment between curriculum and assessment became more pressing. Rather than framing the challenge as resistance, this account conceptualises it as a legitimate constraint, encompassing limited faculty capacity, uneven institutional readiness and competing clinical demands. Drawing on adaptive leadership and change management theory, the article argues that sustainable reform may depend less on achieving broad consensus and more on mobilising those already prepared to act. A 'coalition of the willing', composed largely of early-career specialists with expertise in competency-based education and digital systems, enabled both curriculum reform and alignment with assessment, alongside key changes including digital examination processes and a standardised objective structured clinical examination across training institutions. This approach was balanced by deliberate strategies to maintain institutional cohesion through ongoing engagement with governance structures. The commentary argues that mobilising readiness is a principled leadership response and that meaningful reform requires acting within constraint while preserving institutional cohesion. In this balance lies the work of leadership in complex professional systems.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"419"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiologies of pericardial effusion among medical patients at Nelson Mandela Academic Hospital, Mthatha, South Africa: A cross-sectional study.","authors":"Thandazile O Fathuse, Guillermo A Pulido Estrada","doi":"10.4102/jcmsa.v4i1.401","DOIUrl":"10.4102/jcmsa.v4i1.401","url":null,"abstract":"<p><strong>Background: </strong>Pericardial effusion aetiology varies across geographical locations and epidemiological contexts. In the developing world, tuberculosis (TB), catalysed by human immunodeficiency virus (HIV), is the leading aetiology, while in the developed world, it is idiopathic. The TB epidemic and paucity of recent, regional context aetiological profiling may overshadow other aetiologies in the empirical treatment guidelines.</p><p><strong>Methods: </strong>A retrospective cross-sectional study of clinical records was conducted to investigate the aetiologies of pericardial effusion in adult patients at Nelson Mandela Academic Hospital (NMAH) in Mthatha, South Africa, between January 2022 and October 2025.</p><p><strong>Results: </strong>A total of 141 patients were included in this study, with females constituting 52.5% and males (47.5%). The most common presentation symptom was dyspnoea (97.9%), followed by fatigue (84.4%). The most common signs on examination were muffled heart sounds (92.2%) and increased jugular venous pressure (JVP) (61.0%). Idiopathic pericardial effusion was the most common aetiology (29.8%), followed closely by TB (29.1%) and malignancy (9.9%). Among HIV-positive patients, TB was the predominant cause (55.6%), followed by HIV-related pericardial effusion (25.9%). In contrast, HIV-negative patients most commonly had idiopathic pericardial effusion (35.1%), followed by TB (22.8%) and malignant causes (11.4%).</p><p><strong>Conclusion: </strong>Pericardial effusion in this setting has a heterogeneous aetiological profile and therefore calls for a systematic diagnostic approach to improve aetiological diagnosis and guide appropriate management in high TB and HIV prevalence settings.</p><p><strong>Contribution: </strong>The addition to the limited regional data on the aetiologies of pericardial effusion in a resource-limited South African setting will inform appropriate diagnostic prioritisation, empiric management strategies and resource allocation in similar settings.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"401"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and foetal factors contributing to caesarean section rates at Chris Hani Baragwanath Academic Hospital, a tertiary care centre in South Africa.","authors":"Linda C Taptue Noumsi, Evelyn Ngwa Lumngwena, Poovangela Naidoo","doi":"10.4102/jcmsa.v4i1.325","DOIUrl":"10.4102/jcmsa.v4i1.325","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Caesarean section (CS) rates remain high globally, increasing healthcare costs and maternal-neonatal complications. The World Health Organization (WHO) recommends the Robson Ten Group Classification System (RTGCS) to assess and compare CS rates and reduce primary CS, which contributes to repeat procedures and associated risks. This study aimed to analyse indications for CS using RTGCS, maternal outcomes using WHO near-miss criteria, and pre- and post-delivery foetal conditions at a tertiary referral hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cross-sectional study was conducted on CS deliveries in an African hospital from 01-30 June 2022. Data were analysed using bivariate and multivariate analysis with Fisher's exact test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1,306 deliveries during the study period, 695 (53.2%) were CS. Robson Group 5 was the largest contributor (32.2%), followed by Groups 2 (16.4%) and 4 (12.8%). Foetal distress was the leading indication for CS (47.2%), followed by previous CS (declining vaginal birth after caesarean [VBAC]) (8.2%) and previous uterine scar × 2 in labour (5.8%). Mothers with a previous uterine scar accounted for 25.1% of all CSs, with 6.9% of them requiring high care. Maternal near-miss events occurred in 0.6% of cases. Group 5 had the highest maternal morbidity. Maternal risk factors that contributed to poor foetal outcome in this category were previous CS, chronic hypertension, gestational diabetes, poor obstetric history and obesity. Preoperatively, 62.4 % of foetuses had pathological non-stress tests (NSTs); 30.7% of NSTs were normal. Despite this, neonatal outcomes were favourable. Although no umbilical cord pH was done when the Apgar was &gt; 7, those babies were discharged and coped well in the ward. The stillbirth risk was 12 times higher (OR 12.10, CI 4.29-34.14, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) in women with adverse maternal outcomes, and low 5-min Apgar scores had a 6-fold increased odds in these women (OR 5.83, CI 2.79-12.18, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Maternal near-miss events were strongly associated with adverse neonatal outcomes; the main causes of maternal near misses were peripartum haemorrhage and sepsis. Women who experienced a near-miss had 12 times the odds of stillbirth (OR 12.10, 95% CI 4.29 -34.14, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and nearly six times the odds of a low Apgar score at 5 min (OR 5.83, 95% CI 2.79-12.18, &lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;High CS rates reflect tertiary care burden, with the majority falling within Robson Group 5. This group was the most frequent contributor to CS, and foetal distress was the leading indication for CS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution: &lt;/strong&gt;This was followed by factors related to previous uterine scars. Women with prior uterine scars frequently had a repeat CS and showed notable care needs. Although most foetuses had abnormal preoperative NSTs, overall neonatal outcomes were favourable. However, maternal near miss ","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"325"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating skin of colour into generalist dermatology education: A metacognitive framework.","authors":"Husna Moola, Willem I Visser","doi":"10.4102/jcmsa.v4i1.347","DOIUrl":"10.4102/jcmsa.v4i1.347","url":null,"abstract":"<p><p>Teaching skin of colour (SOC) is essential to equitable dermatologic care. Historically dermatology teaching has favoured lighter skin tones - fostering inequitable care of patients. Although significant advancements in teaching SOC have been made, these are predominantly addended to curricula. Limited dedicated contact time in dermatology and competing study needs may lead to undergraduate medical students and generalists deprioritising adjunctive SOC training. Using a metacognitive framework, we propose SOC should be embedded across all teaching materials for medical students and generalists, that is, skin in colour. Each common dermatosis should be illustrated using a triptych of clinical images: one each from approximate Fitzpatrick I/II, III/IV and V/VI skin tones. When learners encounter a clinical pattern across multiple skin tones, they must compare what is shared and what differs. Nuanced morphological teaching and multiple examples of the same condition allow for in-built repetition of key features of each disease, while the skin tone interleaving solidifies students' ability to identify dermatoses in all skin tones. Clinical pattern recognition across <i>all</i> skin tones is thereby linked to hierarchical schema of differential diagnoses and management - allowing students to subsequently access all these components simultaneously in clinical practice. We acknowledge that this approach only addresses ability to recognise clinical signs and diagnose conditions already included in teaching materials. Cultural competence and regional epidemiology are essential to an inclusive curriculum.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"347"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Troponin T in stable patients with penetrating chest trauma: A diagnostic study.","authors":"Nafi Y Alam, Faatimah A Asmal, Mikaela de Ponte, Yusuf E Patel, Malaaika I Siddique, Bongumusa Sithole, Dineo Mphago, Samukelisiwe Mpembe, Maeyane S Moeng, Estelle Laney, Shumani Makhadi","doi":"10.4102/jcmsa.v4i1.402","DOIUrl":"10.4102/jcmsa.v4i1.402","url":null,"abstract":"<p><strong>Background: </strong>Penetrating chest trauma is a leading cause of mortality in South Africa. In haemodynamically stable patients with injuries within the cardiac box, occult cardiac injury remains difficult to detect, particularly in resource-limited settings. The diagnostic utility of troponin T in this population is poorly defined.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on haemodynamically stable patients presenting with penetrating anterior chest injuries to Charlotte Maxeke Johannesburg Academic Hospital between May 2022 and June 2024. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of serum troponin T were calculated against subxiphoid pericardial window, surgical findings, ultrasound and electrocardiography.</p><p><strong>Results: </strong>Among 256 patients (96% male; median age 31 years), 65% sustained stab wounds and 35% gunshot wounds. Serum Troponin T demonstrated high sensitivity (90.5% pooled against definitive modalities) and an NPV of up to 88.8% in concordance analysis with commonly used screening modalities (non-reference comparators); NPV against definitive reference standards ranged from 50.0% to 66.7%, but had low specificity (37.5% pooled). Overall mortality was 3.9% and was significantly associated with haemopericardium (<i>p</i> = 0.020) and pleural injury (<i>p</i> = 0.029).</p><p><strong>Conclusion: </strong>Serum Troponin T offered high sensitivity and NPV for excluding occult cardiac injury in haemodynamically stable patients, supporting its role as an accessible screening adjunct in resource-constrained emergency departments.</p><p><strong>Contribution: </strong>This study represents the largest cohort evaluating serum troponin T in haemodynamically stable penetrating chest trauma, addressing a critical evidence gap. The findings are directly relevant to South African clinical practice and align with the journal's focus on improving patient care in resource-limited settings.</p>","PeriodicalId":521047,"journal":{"name":"Journal of the colleges of medicine of South Africa","volume":"4 1","pages":"402"},"PeriodicalIF":0.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}