Epidemiology of Patients with Acute Conflict-Related Extremity Injuries Sustained in Syria and Iraq: An Observational Study from Two Civilian Trauma Hospitals

Introduction: In 2023, conflict-related injuries resulted in 172 thousand fatalities. A majority of those killed and injured in armed conflicts are civilians. The most common anatomical site of conflict-related injury for civilians is the extremities. There is a need for increased knowledge on the epidemiology of civilian casualties. This study aims to describe the epidemiology of a population treated for conflict-related extremity injuries at civilian hospitals. Methods: Data were derived from a pragmatic randomized controlled trial performed at two civilian trauma hospitals in Iraq and Jordan with patients injured in Iraq or Syria. Recruited patients were adults (≥18 years) with an acute (<72 h) conflict-related extremity injury not suitable for primary closure. Results: Median age was 28 (interquartile range IQR 21–34) years. 155/165 (94%) patients were male. On admission, the median systolic blood pressure was 120 (IQR 110–130) mmHg, the median heart rate was 96 (IQR 85–110) beats per minute, and the median hemoglobin level was 133 (IQR 113–144) g/L. 93/165 (56%) patients had at least one fracture. The most common mechanism of injury was gunshot (100/165 61% patients), followed by blast (63/165 38% patients). 43/165 (26%) patients had concomitant injuries. Bleeding requiring blood transfusion affected 56/165 (35%) patients. Only 1 patient received more than 10 units of packed red blood cells. Wound infection was found in 29/165 (18%) patients. The median length of stay was 10 (IQR 5–37) days. After 5 days, 92/165 (56%) patients had obtained wound closure. One (1%) patient died during hospital stay. Conclusion: Males were highly overrepresented amongst the patients. Compared to previous similar studies, gunshot as a mechanism of injury was unusually frequent. Fractures were common, including open fractures. Bleeding was a common complication, but massive transfusions were rare. The mortality of the patients was low in comparison to non-conflict civilian trauma hospitals.