Characteristics of the injuries of Syrian refugees sustained during the civil war

BACKGROUND: During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery.
METHODS: Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively
RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head–neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%).
CONCLUSION: The results of this study indicated that head–neck, chest–abdomen, and multiple body injuries are the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.

Suriyeli mültecilerin süren iç savaþ sýrasýndaki yaralanma özellikleri

AMAÇ: Savaþlar sýrasýnda çok sayýda sivil, sýklýkla yüksek kinetik enerjili ateþli silahlar, bomba ve þarapnel etkisiyle ciddi yaralanmalarla karþý karþýya kalmýþlardýr. Savaþ yaralýsý olgularýn triyajý, cerrahi prosedürleri ve yoðun bakým takipleri oldukça zor ve karmaþýk süreçleri içerir. Biz bu çalýþmada, Suriye Ýç Savaþý sýrasýnda yaralanan ve acil operasyon gerektiren olgularýn demografik ve travmatik özelliklerini inceledik.
GEREÇ VE YÖNTEM: Türkiye’nin güneyindeki Suriye sýnýrýndan Mart 2012 ve Ocak 2013 arasýnda Kilis Devlet Hastanesi’ne getirilen 8318 Suriyeli yaralý sýðýnmacý arasýndan acil olarak operasyona alýnan 707 olgunun travmatik, cerrahi ve yoðun bakým takip özellikleri, elektronik datalar üzerinden geriye dönük olarak incelendi.
BULGULAR: Olgulardaki en sýk yaralanma nedeni yüksek kinetik enerjili ateþli silahlar (%83.75) idi. Acil servisten direkt olarak operasyon odasýna alýnan 707 olgunun %93.2’si erkek cinsiyetinde yaþ ortalamasý 26.1±12.1 ve çocuk olgularýn yaþ ortalamasý ise 11.7±3.41 olarak saptandý. En sýk yaralanan vücut bölgesi baþ-boyun idi (%52.7). New Injury Severity Score (NISS): 42.5±11.2 ve American Society of Anesthesiologists (ASA) Score: 3.2±0.7 olarak bulundu. Ameliyatta hayatýný kaybeden olgu sayýsý yedi, hasar kontrol cerrahisi uygulanan olgu sayýsý 204 ve ameliyat sonrasý periyotta yoðun bakýma yatýrýlan olgu sayýsý ise 233 olarak bulundu.Yoðun bakýmda yatýþ süresi 4.67±1.32 idi.Yaþayan hastalarda ilk 24 saatte bakýlan invaziv ölçümler (pH, hemoglobin, vücut ýsýsý, ortalama arteriyal kan basýncý) ve International Normalized Ratio (INR) daha yüksek bulundu. Yaþayabilen hastalar için kullanýlan kan ürünü miktarlarý daha azdý ve bu hastalarda NISS 29.7±10.1 olarak bulundu. Acil operasyon sonrasý yoðun bakýmda takip edilen tüm hastalardaki mortalite oraný %45 ve en düþük sað kalým oraný nöroþirürji olgularýna aitti (%24.1).
TARTIÞMA: Bu çalýþmanýn verileri, Suriye Ýç Savaþý sýrasýnda tahrip gücü yüksek olan savaþ silahlarý ile yaralanarak Türkiye’ye getirilen ve acil operasyona alýnan Suriyeli sivillerde baþ-boyun, göðüs-abdomen ve çoklu vücut yaralanmalarýnýn sýk görüldüðüne, acil cerrahi operasyon sayýlarýnýn fazla ve yoðun bakým takip sürelerinin uzun olduðuna, mortal olgularda ise NISS ve ASA skorlarýnýn anlamlý bir þekilde yüksek olduðuna iþaret etmektedir.