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Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an
Mustafa Tuşat1, İsmail Özmen2, Mehmet Semih Demirtaş3
1Department of Pediatric Surgery, Faculty of Medicine, Aksaray University, Aksaray-Türkiye.
Insights
Pediatric penetrating abdominal firearm injuries (PAFI) in wartime are severe. High trauma index and low Pediatric Trauma Score (PTS) predict worse outcomes, emphasizing rapid intervention and transport in conflict zones.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Global Health
Background:
- Firearm-related abdominal injuries in children present significant challenges with high mortality and complication rates.
- The Syrian civil war has led to an increase in high-velocity firearm and shrapnel injuries among children in the region.
Purpose of the Study:
- To evaluate factors influencing mortality and complications in pediatric penetrating abdominal firearm injuries (PAFI) sustained during the Syrian civil war.
- To identify predictive markers for adverse outcomes in pediatric PAFI.
Main Methods:
- A case series of 53 pediatric patients (6 months to 17 years) with PAFI treated at Kilis State Hospital between January 2016 and February 2017.
- Data collected included sociodemographics, time to surgery, number of injured organs, injury type, presence of major vascular or thoracic injuries, colostomy, Penetrating Abdominal Trauma Index (PATI), Pediatric Trauma Score (PTS), and shock status.
Main Results:
- A high PATI was significantly associated with increased complication rates and mortality (P<0.001 and P=0.002).
- Lower PTS scores significantly correlated with higher complication rates and mortality (P=0.001 and P<0.001). Mortality was 0% with PTS > 8 and 27.3% with PTS ≤ 8 (P=0.003).
- Shock status significantly increased mortality (P<0.001), and increased intra-abdominal organ injury also significantly impacted complications and mortality (P<0.001 and P=0.002).
Conclusions:
- The PATI and PTS are effective tools for predicting mortality and morbidity in pediatric patients with PAFI.
- Rapid and effective initial interventions, followed by appropriate transport, are critical for improving outcomes in this vulnerable patient population in conflict zones.
Background:
Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated.
Methods:
This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients' sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated.
Results:
In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively).
Conclusion:
The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.
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