Abstract
BackgroundManagement of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control. A civilian hospital based in a war zone can rarely rely upon these principles because it normally has limited resources and lacks rapid medical evacuation. We designed this study to describe organ injury patterns and factors related to mortality in patients with penetrating abdominal war injuries in a civilian hospital in an active war zone in Afghanistan, examine how these findings differ from those in a typical military setting, and evaluate how they might improve patients’ care.MethodsWe reviewed the records of all patients admitted at the Lashkargah “Emergency” hospital with penetrating abdominal injuries treated from January 2006 to December 2016. Demographic and clinical data were recorded; univariate and multivariate analyses were used to identify variables significantly associated with death.ResultsWe treated 953 patients for penetrating abdominal injury. The population was mainly civilian (12.1% women and 21% under 14). Mean age was 23 years, and patients with blast injuries were younger than in the other groups. The mechanism of injury was bullet injury in 589 patients, shell injury in 246, stab wound in 97, and mine injury in 21. The most frequent abdominal lesion was small bowel injury (46.3%). Small and large bowel injuries were the most frequent in the blast groups, stomach injury in stab wounds. Overall mortality was 12.8%. Variables significantly associated with death were age > 34 years, mine and bullet injury, length of stay, time since injury > 5 h, injury severity score > 17, and associated injuries.ConclusionsEpidemiology and patterns of injury in a civilian hospital differ from those reported in a typical military setting. Our population is mainly civilian with a significant number of women and patients under 14 years. BI are more frequent than blast injuries, and gastrointestinal injuries are more common than injuries to solid organs. In this austere setting, surgeons need to acquire a wide range of skills from multiple surgical specialties. These findings might guide trauma and general surgeons treating penetrating abdominal war wounds to achieve better care and outcome.
Highlights
Management of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control
We designed this study primarily to describe organ injury patterns and factors related to mortality in patients with penetrating abdominal war injuries in a civilian hospital in an active war zone in Afghanistan
We retrospectively reviewed the records of all patients with penetrating abdominal injuries admitted and operated upon at the “Emergency” non-governmental (NGO) hospital in Lashkargah, Afghanistan, from January 2006 to December 2016
Summary
Management of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control. Today’s surgical strategy in the management of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control, followed by rapid evacuation to a referral hospital for definitive treatment [11], but with the exception of reports from the International Committee of the Red Cross (ICRC) field hospitals [10, 12,13,14], most reports come from military hospitals or civilian referral hospitals treating the war wounded [2,3,4, 7, 8, 15,16,17,18]. A civilian hospital based in a war zone can rarely rely upon these principles because it normally has limited resources, lacks echeloned care and rapid medical evacuation, and has to undertake primary as well as secondary surgery. Having a better insight into these possible differences might improve these patients’ care and outcome
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