Outcome for Patients With War-Associated Extremity Wound Infection

Extremity wounds and fractures constitute the majority of war-associated traumatic injuries, both for civilians and combatants. War-associated injuries are often contaminated with foreign material, leading to infection. Wound infections is considered a major risk to life and restoration of function in war-wounded patients surviving past the first hours. In a cohort study the investigators aim to assess whether the infection itself affects patient outcome (i.e. amputation, death) when comparing patients with and patients without infection.

Study Overview

• Status: Completed
• Conditions: Wounds and Injuries
• Intervention / Treatment: Other: Infected; Other: Not infected

Detailed Description

Armed violence has occurred intermittently in northwestern Pakistan and neighboring Afghanistan since the beginning of the 1980s. In 1981 the International Committee of the Red Cross (ICRC) opened a hospital in Peshawar, Pakistan, to care for the injured from the armed conflict in Afghanistan. In 2004 the number of patients increased as a result of the emerging divergence between the State of Pakistan and militant groups in the Northwestern Pakistan. Yearly about 1000 patients with war-associated injuries, predominantly caused by gunshots and explosive devices have been treated for free at the ICRC hospital in Peshawar. The hospital is now closed.

War-associated injuries are generally treated according to the ICRC war surgical protocol. Research on the epidemiology of and risk factors for wound infection in patients with war-associated injuries is limited and primarily include military combatants, leading to a selection of young males. Due to the use of body armor and forward surgical teams this data may not be applicable to a civilian setting. It is unknown to what extent wound infection itself is a factor contributing to serious complications such as amputation and death. Knowledge is needed to gear resources towards those most in need. This research makes use of a unique database that contains both civilians and combatants of both sexes and all ages. The investigators aim to assess whether the infection itself affects patient outcome (i.e. amputation, death) when comparing patients with and patients without infection.

• Study Type: Observational
• Enrollment (Actual): 843

Contacts and Locations

Study Locations

• Pakistan
  • Khyber Pakhtunkhwa
    • Peshawar, Khyber Pakhtunkhwa, Pakistan
      • International Committee of the Red Cross hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Consecutive patients treated at the hospital in Peshawar between September 27, 2010 and May 9, 2012 that meet eligibility criteria.

Description

Inclusion Criteria:

• Patients that have received treatment for war-associated extremity wounds
• Patients that present at the hospital within 72 hours of injury
• Patients with valid data on baseline wound status.

Exclusion Criteria:

• Patients that are re-admitted during the study period, i.e. patients that received treatment during the study period and are later re-admitted will only be counted as one patient.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Extremity wound; Patients with extremity wounds. Infected and not infected patients will be compared.	Other: Infected; Extremity wound, infected; Other: Not infected; Extremity wounds, non-infected

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amputation	In-hospital extremity amputation. Upper or lower extremity, all levels.	From hospital admission to discharge, an average of 15 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Death	In-hospital death	From hospital admission to discharge, an average of 15 days

Collaborators and Investigators

• Sponsor: Karolinska Institutet
• Collaborators: The International Federation of Red Cross and Red Crescent Societies
• Investigators: Principal Investigator: Jonas Malmstedt, PhD, Karolinska Institutet

Study record dates

Study Major Dates

• Study Start (Actual): September 27, 2010
• Primary Completion (Actual): May 9, 2012
• Study Completion (Actual): May 9, 2012

Study Registration Dates

• First Submitted: February 22, 2018
• First Submitted That Met QC Criteria: March 12, 2018
• First Posted (Actual): March 13, 2018

Study Record Updates

• Last Update Posted (Actual): March 13, 2018
• Last Update Submitted That Met QC Criteria: March 12, 2018
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Infections; Wounds and Injuries; Wound Infection
• Other Study ID Numbers: KISOS003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: The use of identification numbers will ensure anonymity of the data. All data will remain confidential throughout the data entry and analysis process by encryption. Individual patient data will not be distributed outside the study location, or appear in any report or publication.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No