Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

Trelles, Miguel; Stewart, Barclay T; Hemat, Hamayoun; Naseem, Masood; Zaheer, Sattar; Zakir, Mutallib; Adel, Edris; Overloop, Catherine Van; Kushner, Adam L.

doi:10.1016/j.surg.2016.05.024

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…This is likely a result of the global work against landmines by both governmental and non-governmental bodies that resulted in the Ottawa treaty endorsed by a majority of states in 1997 prohibiting their use [ 12 ]. In-hospital mortality, although slightly higher among females, did not differ significantly between sexes, and the total figure of 4.8% is in line with other studies from the same geographical area reporting rates of 2.5–7.0% [ 9 , 13 , 14 ]. Females consumed more hospital resources per person than did males since they were subjected to more surgical procedures involving the skull, thorax and abdomen, had more procedures as a whole, and given more blood transfusions.…”

Section: Discussionsupporting

confidence: 90%

Hospital Workload for Weapon‐Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males

et al. 2017

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BackgroundCivilians constitute 33–51% of victims in armed conflicts. Several reports on civilian injuries exist, but few have focused on injuries afflicting females. We analyzed routinely collected data on weapon-related injuries from the International Committee of the Red Cross (ICRC) hospital in northwestern Pakistan in order to define injury patterns and types of surgical treatment for females.MethodsA total of 3028 patient files (376 females) from consecutively admitted patients to the ICRC-hospital in Peshawar from February 2009 to May 2012 were included. Information regarding injury-mechanism, time since injury, vital parameters at admission, type of injury, treatment and basic outcome was extracted from the files and analyzed. Comparisons between gender and age-groups were done by cross-table analyses or nonparametric tests.ResultsFemales were younger than males (20 vs. 25 years), arrived sooner after injury (24 vs. 48 h) (p < 0.001 for both) and were victims of bombs and missiles more frequently (64.4 vs. 54.6%) (p < 0.001). Vital parameters such as systolic blood pressure (110 vs. 113 mmHg) and pulse rate (100 vs. 86) were more affected at admission (p < 0.001 for both). Females were subjected to surgery (83.0 vs. 77.4%) (p < 0.05) and were given blood transfusions more often (18.8 vs. 13.6%) (p < 0.01). No differences in amputations or in-hospital mortality were found.ConclusionsFemales treated at the ICRC-hospital in northwestern Pakistan are markedly affected by indiscriminate weapons such as bombs and missiles. Their average consumption of surgery is greater than for males, and this might be relevant in planning for staffing and facility needs in similar contexts.

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Section: Discussionsupporting

confidence: 90%

Hospital Workload for Weapon‐Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males

et al. 2017

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“…The surgical workload for paediatric patients of 15.7% that was found in this study is closer to that in military hospitals (16%) [13, 14], than in other humanitarian efforts (30%) [15–19]. This is expected since the ICRC mainly treats weapon-wounded patients.…”

Section: Discussionmentioning

confidence: 48%

“…In conflict, the paediatric workload in military hospitals is 6% of all patients[5–10], and an even greater portion of paediatric patients (18%) is treated in humanitarian hospitals [11, 12]. Additionally, the percentage of paediatric patients is markedly higher among the surgical patient population in military hospitals (16%) [13, 14] as well as in humanitarian efforts (30%) [15–19], which again emphasizes that war-wounded children demand extensive care and resources [5, 8–10, 13, 20–24]. Additionally, younger age (≤ 8 years) has been independently associated with mortality in trauma patients admitted to combat support hospitals in Iraq and Afghanistan [9, 10, 22].…”

Section: Introductionmentioning

confidence: 99%

Global surgery for paediatric casualties in armed conflict

et al. 2019

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BackgroundUnderstanding injury patterns specific for paediatric casualties of armed conflict is essential to facilitate preparations by organizations that provide medical care in conflict areas. The aim of this retrospective cohort study is to identify injury patterns and treatment requirements that are specific for paediatric patients in conflict zones.MethodsCharacteristics of children (age < 15 years) treated in medical facilities supported by the International Committee of the Red Cross (ICRC) between 1988 and 2014 in Kabul, Kao-i-Dang, Lokichogio, Kandahar, Peshawar, Quetta and Goma were analysed; patient characteristics were compared between treatment facilities and with those of adult patients (age ≥ 15 years).ResultsOf the patients listed in the database, 15% (5843/38,088) were aged < 15 years. The median age was 10 years (IQR 6–12); 75% (4406/5843) were male. Eighty-six percent (5012/5,843) of the admitted children underwent surgery, with a median of 2 surgeries per patient (IQR 1–3). When compared with adult patients, children were more frequently seen with fragment injuries, burns and mine injuries; they had injuries to multiple body regions more often and had higher in-hospital mortality rates.ConclusionsChildren more often sustained injuries to multiple body regions and had higher in-hospital mortality than adults. These findings could have implications for how the ICRC and other organizations prepare personnel and structure logistics to meet the treatment needs of paediatric victims of armed conflicts.

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“…This coupled with limited healthcare provision close to the battlefield, especially during the early stages of the campaign, implies that many patients may have died prior to reaching EMC. This is supported by studies investigating the epidemiology of trauma patients in Kunduz, Afghanistan, a conflict setting with significant shortcomings in prehospital care, which found in-hospital mortality rates between 0.1 and 12.6% [15, 16]. The very low incidence of thoracic injuries and thoracotomies in this study is also an indication of a high prehospital mortality, since traumatic intrathoracic events such as tension pneumothoraces and hemothoraces can rapidly be fatal unless care is initiated early [17].…”

Section: Discussionmentioning

confidence: 86%

Epidemiology of Trauma Patients from the Mosul Offensive, 2016–2017: Results from a Dedicated Trauma Center in Erbil, Iraqi Kurdistan

et al. 2018

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IntroductionMost epidemiological studies from conflicts are restricted to either combatants or civilians. It is largely unknown how the epidemiology differs between the two groups. In 2016, an Iraqi-led coalition began retaking Mosul from the terrorist group Islamic State of Iraq and Syria. One key institution that received trauma patients from Mosul was Emergency Management Center (EMC) in Erbil, 90 km away. The aim of this study was to describe the epidemiology, morbidity, and mortality of civilians and combatants admitted during the ongoing conflict.MethodThis retrospective cohort study utilized routinely collected data on patients with conflict-related injuries who were admitted to EMC between October 16, 2016, and July 10, 2017. Data processing and analysis was carried out using JMP 13. Categorical variables were compared using Fisher’s exact test.ResultsThe analysis included 1725 patients, out of which 46% were civilian. Ordnance accounted for most injuries (68%), followed by firearms (18%) and improvised explosive devices (IEDs) (14%). The proportion of IED-related injuries among combatants were almost three times that of civilians. The proportions of abdominal injuries, need for surgery, laparotomies, and amputations were significantly higher among civilians than among combatants. The mortality rate was 0.5%.DiscussionThe fact that civilians had greater surgical needs than combatants may be explained by several factors including a lack of ballistic protection. The extremely low mortality rate indicates significant gaps in prehospital care and transport. Our results may provide useful information to guide medical preparedness and response during future conflicts.Clinicaltrials.gov IDNCT03358758.

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Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

Cited by 22 publications

References 16 publications

Hospital Workload for Weapon‐Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males

Hospital Workload for Weapon‐Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males

Global surgery for paediatric casualties in armed conflict

Epidemiology of Trauma Patients from the Mosul Offensive, 2016–2017: Results from a Dedicated Trauma Center in Erbil, Iraqi Kurdistan

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