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Trends in Demographics and Surgical Treatment of Weapon-Related Limb Injuries Over Two Decades in a Resource-Scarce Setting
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.ORCID iD: 0000-0001-7002-7768
Univ Southern Denmark, Denmark.
Int Comm Red Cross, Switzerland.
Karolinska Inst, Sweden.
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2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 11, p. 2681-2688Article in journal (Refereed) Published
Abstract [en]

Background In the past decades, surgical management of limb injuries in high-resource settings has improved. The possibility of limb salvage has increased. It is not known whether similar changes have transpired in resource-scarce conflict settings. Methods Retrospective cohort study using routinely collected patient data from the International Committee of the Red Cross hospitals in Pakistan was conducted. Consecutive data from 2009 to 2012 (535 patients) and randomly selected data from 1992 to 1995 (463 patients) were used. Only patients with weapon-related limb injuries were included. Differences in surgical procedures were assessed with logistic regression to adjust for confounding factors. Results Less injuries were related to mines in 2009-2012 than in 1992-1995 (3.7% vs. 20.3%, p amp;lt; 0.0001), but injuries from bombs, shells and fragments were more frequent (38.5% vs. 19.4%, p amp;lt; 0.0001) as were injuries with only a small degree of tissue damage (42.0% vs. 31.1%, p = 0.0004). In the logistic regression, the time period did not affect the risk of amputation, debridement, length of hospital stay or in-hospital mortality. The use of external fixation (OR 0.56, 95% CI 0.33-0.96, p = 0.04), split skin grafts (OR 0.31, 95% CI 0.21-0.45, p amp;lt; 0.0001) and blood transfusion (OR 0.43, 95% CI 0.28-0.66, p = 0.0001) was less frequent in 2009-2012. Conclusion In this resource-scarce conflict setting, the risk of amputation appears unchanged over time, while the use of external fixation and split skin grafts was less common in 2009-2012 than in 1992-1995. These results contrast with the improved limb salvage results seen in high-resource settings. It likely reflects the challenges of providing advanced limb-preserving techniques in a resource-scarce setting.

Place, publisher, year, edition, pages
SPRINGER , 2019. Vol. 43, no 11, p. 2681-2688
National Category
Surgery
Research subject
Disaster Medicine
Identifiers
URN: urn:nbn:se:liu:diva-161121DOI: 10.1007/s00268-019-05110-yISI: 000488847800005PubMedID: 31407093OAI: oai:DiVA.org:liu-161121DiVA, id: diva2:1366130
Note

Funding Agencies|Sigurd and Elsa Goljes Memorial Foundation; ALF grants, Region Ostergotland, Sweden [LIO-799621, LA2016-0457]

Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-12-12

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Muhrbeck, MånsWladis, AndreasAndersson, Peter
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