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

Maximilian P Nerlander, Rawand Musheer Haweizy, Moayad Abdullah Wahab, Andreas Älgå, Johan von Schreeb, Maximilian P Nerlander, Rawand Musheer Haweizy, Moayad Abdullah Wahab, Andreas Älgå, Johan von Schreeb

Abstract

Introduction: Most 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.

Method: This 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.

Results: The 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%.

Discussion: The 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 id: NCT03358758.

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Age distribution and combatant status (n = 1725). A total of 13 individuals whose age was unknown were excluded from the age analysis but included in the analysis pertaining to sex and combatant status

References

    1. Roy N, Gerdin M, Ghosh S, Gupta A, Kumar V, Khajanchi M, et al. 30-Day in-hospital trauma mortality in four urban university hospitals using an indian trauma registry. World J Surg. 2016;40(6):1299–1307. doi: 10.1007/s00268-016-3452-y.
    1. Spiegel PB. The mosul trauma response. Palo Alto: Stanford University; 2018.
    1. Guha-Sapir D, Schlüter B, Rodriguez-Llanes JM, Lillywhite L, Hicks MH-R. Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011–16. Lancet Glob Health. 2018;6(1):e103–e110. doi: 10.1016/S2214-109X(17)30469-2.
    1. Kotwal RS, Scott LL, Janak JC, Tarpey BW, Howard JT, Mazuchowski EL, Butler FK, Shackelford SA, Gurney JM, Stockinger ZT. The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq. J Trauma Acute Care Surg. 2018;85(1S):S112–S121.
    1. Champion HR, Holcomb JB, Young LA. Injuries from explosions: physics, biophysics, pathology, and required research focus. J Trauma. 2009;66(5):1468–1477. doi: 10.1097/TA.0b013e3181a27e7f.
    1. Greer N, Sayer N, Kramer M, Koeller E, Velasquez T (2016) VA evidence-based synthesis program reports. Prevalence and epidemiology of combat blast injuries from the military cohort 2001–2014. Department of Veterans Affairs (US), Washington, DC
    1. Smith S, Devine M, Taddeo J, McAlister VC. Injury profile suffered by targets of antipersonnel improvised explosive devices: prospective cohort study. BMJ Open. 2017;7(7):e014697. doi: 10.1136/bmjopen-2016-014697.
    1. Wolf SE, Kauvar DS, Wade CE, Cancio LC, Renz EP, Horvath EE, et al. Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom. Ann Surg. 2006;243(6):786–792. doi: 10.1097/01.sla.0000219645.88867.b7.
    1. Hicks MH-R, Dardagan H, Bagnall PM, Spagat M, Sloboda JA. Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003–10: a descriptive study. The Lancet. 2011;378(9794):906–914. doi: 10.1016/S0140-6736(11)61023-4.
    1. Älgå A, Wong S, Shoaib M, Lundgren K, Giske CG, von Schreeb J, et al. Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan. BMC Infect Dis. 2018;18(1):233. doi: 10.1186/s12879-018-3149-y.
    1. Nerlander MP, Leidman E, Hassan A, Sultan AS, Hussain SJ, Browne LB, Bilukha OO (2017) Fatalities from firearm-related injuries in selected governorates of Iraq, 2010-2013. Prehosp Disaster Med 32(5):548-555
    1. Gerdin M, Roy N, Dharap S, Kumar V, Khajanchi M, Tomson G, et al. Early hospital mortality among adult trauma patients significantly declined between 1998–2011: three single-centre cohorts from Mumbai, India. PLoS ONE. 2014;9(3):e90064. doi: 10.1371/journal.pone.0090064.
    1. Roy N, Kizhakke Veetil D, Khajanchi MU, Kumar V, Solomon H, Kamble J, et al. Learning from 2523 trauma deaths in India-opportunities to prevent in-hospital deaths. BMC Health Serv Res. 2017;17(1):142. doi: 10.1186/s12913-017-2085-7.
    1. Hunt P. 7 Mass casualty incidents: a review of triage severity planning assumptions. Emerg Med J. 2017;34(12):A865.
    1. Hemat H, Shah S, Isaakidis P, Das M, Kyaw NT, Zaheer S, et al. Before the bombing: high burden of traumatic injuries in Kunduz Trauma Center, Kunduz, Afghanistan. PLoS ONE. 2017;12(3):e0165270. doi: 10.1371/journal.pone.0165270.
    1. Trelles M, Stewart BT, Hemat H, Naseem M, Zaheer S, Zakir M, et al. Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015. Surgery. 2016;160(5):1414–1421. doi: 10.1016/j.surg.2016.05.024.
    1. Dennis BM, Bellister SA, Guillamondegui OD. Thoracic trauma. Surg Clin N Am. 2017;97(5):1047–1064. doi: 10.1016/j.suc.2017.06.009.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj