Surgery in Armed Conflicts: Predicting Surgical Treatment Needs and Improving Resource Use in ResourceConstrained Settings

Summary

In armed conflicts, civilian healthcare struggles to cope with limited or no surgical resources. Understanding the relationship between demographics, injury mechanism, and injury patterns to predict what resources are needed is therefore vital. To explore this, medical records were obtained from patients with weapon-related wounds, treated at three International Committee of the Red Cross (ICRC) hospitals. Differences in injury mechanisms, injury patterns, and treatments between the sexes and over time were analysed, as well as the possibility of predicting surgical resource consumption. At these hospitals, most patients were men in their twenties with injuries to their arms or legs. Treatment of soft tissue injuries was the most common surgery type. Less than 20% of patients underwent major surgery and mortality during hospital stay was less than 5%. The use of fracture stabilization measures and skin grafts has decreased in recent decades, while the risk of amputation has remained unchanged. Women were injured to a greater extent by indiscriminate weapons, had more serious injuries, received blood transfusions more often, and were treated with more extensive surgery than men. The descriptive Red Cross Wound Score (RCWS) was better at predicting surgical resource consumption than scoring systems used in civilian trauma care.