Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.003
Brazilian Journal of Anesthesiology
Scientific Article

Assessment of the perioperative period in civilians injured in the Syrian Civil War

Avaliação do período perioperatório em civis feridos na Guerra Civil Síria

Sedat Hakimoglu; Murat Karcioglu; Kasim Tuzcu; Isil Davarci; Onur Koyuncu; Ismail Dikey; Selim Turhanoglu; Ali Sari; Mehmet Acipayam; Celalettin Karatepe

http://dx.doi.org/10.1016/j.bjane.2014.03.003 Braz J Anesthesiol, vol.65, n6, p.445-449, 2015
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Abstract

BACKGROUND: wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS: the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS: the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION: among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

Keywords

Syrian Civil War, Perioperative period, War injury

Resumo

JUSTIFICATIVA: Historicamente, as guerras e seus desafios afligem a humanidade. Na Síria, lesões graves ocorreram devido às armas de fogo e explosivos usados na guerra entre as forças governamentais e civis durante um período de mais de dois anos. MATERIAIS E MÉTODOS: O estudo incluiu 364 pacientes, admitidos no Hospital da Universidade Mustafa Kemal da Faculdade de Medicina (Hatay, Turquia) e submetidos à cirurgia. Os sobreviventes e não sobreviventes foram comparados quanto ao local e tipo da lesão e número de transfusões administradas. A taxa de mortalidade encontrada neste estudo também foi comparada àquelas relatadas em outras guerras civis. RESULTADOS: A média de idade foi de 29 (3-68) anos. Os principais locais de lesão incluíram extremidades (56,0%), cabeça (20,1%), abdome (16,2%), estruturas vasculares (4,4%) e tórax (3,3%). Os tipos de lesões incluíram ferimento de arma de fogo (64,4%), lesão causada por explosão (34,4%) e ferimentos diversos (1,2%). A taxa de sobrevivência foi de 89,6%, enquanto a taxa de mortalidade foi de 10,4%. Observou-se uma diferença significativa entre as taxas de mortalidade neste estudo e aquelas relatadas para as guerras civis da Bósnia e Líbano; e a diferença ficou extremamente significativa quando comparada com as taxas de mortalidade relatadas para as guerras civis do Vietnã e do Afeganistão. CONCLUSÃO: Dentre as lesões relacionadas à guerra, a maior taxa de mortalidade foi observada em lesões de cabeça-pescoço, abdome e vasculares. Acreditamos que a maior taxa de mortalidade na Guerra Civil da Síria, em comparação com as guerras da Bósnia, Vietnã, Líbano Afeganistão, se deva ao fato de os civis terem sido vistos como alvo direto durante a guerra.

Palavras-chave

Guerra Civil Síria, Período pós-operatório, Lesões de guerra

References

Gosselin RA. War injuries, trauma, and disaster relief. Tech Orthop.. 2005;20:97-108.

Garfield RM, Neugut AI. Epidemiologic analysis of warfare: a historical review. JAMA.. 1991;266:688.

Meddings DR. Civilians and war: a review and historical over view of the involvement of non-combatant populations in con- flict situations. Med Confl Surviv.. 2001;17:6-16.

Atiyeh BS, Hayek SN. Management of war-related burn injuries: lessons learned from recent on going conflicts pro- viding exceptional care in unusual places. J Craniofac Surg.. 2010;21:1529-37.

Aboutanos MB, Baker SP. Wartime civilian injuries: epidemiology and intervention strategies. J Trauma.. 1997;43:719-26.

Smith JE. The epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases pre- senting to deployed military hospitals, 2003-2009. Philos Trans R Soc Lond B Biol Sci.. 2011;366:291-4.

Atiyeh BS, Gunn SW, Hayek SN. Military and civilian burn injuries during armed conflicts. Ann Burns Fire Disasters.. 2007;20:203-15.

Owens BD, Kragh Jr JF, Wenke JC. Combat wounds in oper- ation Iraqi Freedom and operation Enduring Freedom. J Trauma.. 2008;64:295-9.

Hess JR, Holcomb JB. Transfusion practice in military trauma. Transfus Med.. 2008;18:143-50.

Murray DJ, Pennell BJ, Weinstein SL. Packed red cells in acute blood loss: dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg.. 1995;80:336-42.

Ketchum L, Hess JR, Hiippala S. Indications for early FFP, cryo- precipitate, and platelets in trauma. J Trauma.. 2006;60:51-8.

VanRooyen MJ, Sloan EP, Radvany AE. The incidence and outcome of penetrating and blunt trauma in central Bosnia: The Nova Bila Hospital for War Wounded. J Trauma.. 1995;38:863-6.

Hardaway 3rd RM. Viet Nam wound analysis. J Trauma.. 1978;18:635-43.

Rautio J, Paavolainen P. Afghan war wounded: experience with 200 cases. J Trauma.. 1988;28:523-5.

Rignault DP. Abdominal trauma in war world. J Surg.. 1992;16:940-6.

Bellamy RF. Combat trauma over view. Textbook of military medicine, anesthesia and peri- operative care of the combat casualty. 1995:1-42.

Sakorafas GH, Peros G. Principles of war surgery: current con- cepts and future perspectives. Am J Emerg Med.. 2008;26:480-9.

Champion HR, Bellamy RF, Roberts CP. A profile of combat injury. J Trauma.. 2003;54:13-9.

Marshall TJ. Combat casualty care: the Alpha Surgical Com- pany experience during operation Iraqi Freedom. Mil Med.. 2005;170:469-72.

Patel TH, Wenner KA, Price SA. A U. S. Army for ward sur- gical team's experience in Operation Iraqi Freedom. J Trauma.. 2004;57:201-7.

Ryan JM, Cooper GJ, Haywood IR. Field surgery on a future conventional battlefield: strategy and wound management. Ann R Coll Surg Engl.. 1991;73:13-20.

Bowyer GW. Afghan War wounded: application of the red cross wound classification. J Trauma.. 1995;38:64-7.

Mannion S, Chaloner E. Principles of war surgery. Br Med J.. 2005;330:1498-500.

Coupland RM. The effect of weapons: defining superfluous injuries and unnecessary suffering. A1 Med Global Surviv.. 1996:3.

Souka HM. Management of gulf war casualties. Br J Surg.. 1992;79:1307-8.

Montgomery SP, Swecki CW, Shriver CD. The evaluation of casualties from Operation Iraqi Freedom on return to the conti- nental United States from March to June 2003. J Am Coll Surg.. 2005;201:7-12.

Schoenfeld AJ, Dunn JC, Belmont PJ. Pelvic, spinal and extrem- ity wounds among combat-specific personnel serving in Iraq and Afghanistan (2003-2011): a new paradigm in military musculo skeletal medicine. Injury.. 2013;44:1866-70.

Odhiambo WA, Guthua SW, Chindia ML. Pattern and clinical characteristics of firearm injuries. East Afr Med J.. 2008;85:107-12.

Peng R, Chang C, Gilmore D. Epidemiology of immediate and early trauma deaths at an urban level I trauma center. Am Surg.. 1998;64:950-4.

Sauaia A, Moore FA, Moore EE. Epidemiology of trauma death: a reassessment. J Trauma.. 1995;38:185-93.

Wiedeman JE, Rignault DP. Civilian versus military trauma dogma: who do you trust?. Mil Med.. 1999;164:256-60.

Eshaya-Chauvin B, Coupland RM. Transfusion requirements for the management of war injured: the experience of the International Committee of the Red Cross. Br J Anaesth.. 1992;68:221-3.

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