TY - JOUR
T1 - Operative trauma in low-resource settings
T2 - The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster
AU - Wong, Evan G.
AU - Dominguez, Lynette
AU - Trelles, Miguel
AU - Ayobi, Samir
AU - Hazraty, Khalil Rahman
AU - Kasonga, Cheride
AU - Basimuoneye, Jean Paul
AU - Santiague, Lunick
AU - Kamal, Mustafa
AU - Rahmoun, Alaa
AU - Kushner, Adam L.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses. Methods A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. Results A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). Conclusion Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.
AB - Background Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses. Methods A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. Results A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). Conclusion Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.
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U2 - 10.1016/j.surg.2014.12.021
DO - 10.1016/j.surg.2014.12.021
M3 - Article
C2 - 25934022
AN - SCOPUS:84929044115
SN - 0039-6060
VL - 157
SP - 850
EP - 856
JO - Surgery (United States)
JF - Surgery (United States)
IS - 5
ER -