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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References
World Health Organization. Injuries and violence: the facts. 2010. Available from: http://www.who.int/violence_injury_prevention/key_facts/en/.
- The injury chart book: a graphical overview of the global burden of injuries.World Health Organization, Geneva2002 (Available from:)
- An estimation of the global volume of surgery: a modelling strategy based on available data.Lancet. 2008; 372: 139-144
- Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries.Arch Surg. 2010; 145: 721-725
- Surgical care during humanitarian crises: a systematic review of published surgical caseload data from foreign medical teams.Prehosp Disaster Med. 2012; 27: 184-189
- Prioritizing injury care: a review of trauma capacity in low and middle-income countries.J Surg Res. 2015; 193: 217-222
- Surgeons without borders: a brief history of surgery at Medecins Sans Frontieres.World J Surg. 2010; 34: 411-414
- Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Medecins Sans Frontieres facilities.Surgery. 2014; 156: 642-649
- Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo.Confl Health. 2010; 4: 6
- Hospital-based trauma registries in Uganda.J Trauma. 2000; 48: 498-502
- Is the Kampala trauma score an effective predictor of mortality in low-resource settings? A comparison of multiple trauma severity scores.World J Surg. 2014; 38: 1905-1911
Article info
Publication history
Accepted:
December 24,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
