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Li C, Jiao J, Hua G, Yundendorj G, Liu S, Yu H, Zhang L, Yang X, Liu L. Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019 : a prospective cohort study. Int J Surg 2024; 110:01279778-990000000-01054. [PMID: 38348839 PMCID: PMC11020088 DOI: 10.1097/js9.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/23/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND To assess the burden and change in incidence, death, and disability-adjusted life years (DALYs) for all-cause-specific injuries among children and adolescents in 204 countries and territories between 1990 and 2019. MATERIALS AND METHODS Data were extracted from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019). Global, regional, and country-level age-standardized rate (per 100,000) of incidence (ASRI), mortality (ASRM), and DALYs (ASRD) with 95% uncertainty interval (95% UI) of injuries were estimated by age, sex, socio-demographic index (SDI), and all-cause specific injuries from 1990 to 2019. RESULTS Overall, the ASRI, ASRM, and ASRD of injury were 9006.18 (95%UI: 7459.74 to 10918.04), 23.04 (20.00 to 26.50), and 2020.19 (1759.47 to 2318.64) among children and adolescents worldwide in 2019, respectively. All the above indicators showed a downward trend from 1990 to 2019. In level 2 cause of injury, both the global transport injury and unintentional injury declined during the study years, while self-harm and interpersonal violence-related injury showed an increasing trend. High SDI regions had higher ASRI of injuries, but low SDI regions had higher ASRM and ASRD of injuries globally in 2019. Males had a higher burden of injuries than those in females. The ASRI of injuries is higher in adolescents aged 15-19 years, whereas the mortality and DALYs rate are higher among children under 5 years old. Moreover, adolescents aged 15-19 years and individuals living in Central Asia, Middle East, and Africa had higher ASRI, ASRM, and ASRD of injuries owing to self-harm and interpersonal violence. Generally, falls and road traffic injuries are the leading cause of injury among the population aged 0-19 years worldwide, but self-harm, interpersonal violence, and conflict and terrorism are also leading types of injuries in some regions, particularly in Low- and Middle-Income Countries. CONCLUSIONS Injury remains a major global public health problem among children and adolescents, although its burden at the worldwide level showed a decreasing trend from 1990 to 2019. Of concern, the burden of injuries caused by transport injuries, and unintentional injuries has shown a downward trend in most countries, while the burden caused by self-harm and interpersonal violence has shown an upward trend in most countries. These findings suggest that more targeted and specific strategies to prevent the burden of injuries should be reoriented, and our study provides important findings for decision-makers and healthcare providers to reduce injury burden among children and adolescents.
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Affiliation(s)
- Cong Li
- Department of ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
- School of Medicine South China University of Technology
| | - Jinghua Jiao
- Department of Anesthesiology, Guangzhou Eighth People’s Hospital, Guangzhou Medical University
- Department of Anesthesiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning
| | - Guangyao Hua
- Department of Cardiovascular Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan
| | - Gantugs Yundendorj
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Shunming Liu
- Department of ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Honghua Yu
- Department of ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou
| | - Lijun Zhang
- Department of Ophthalmology, The Third People’s Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University
- Graduate School, Dalian Medical University, Dalian, People’s Republic of China
| | - Xiaohong Yang
- Department of ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Lei Liu
- Department of ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou
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Aguirre AS, Rojas K, Torres AR. Pediatric traumatic brain injuries in war zones: a systematic literature review. Front Neurol 2023; 14:1253515. [PMID: 37745670 PMCID: PMC10511749 DOI: 10.3389/fneur.2023.1253515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Background Pediatric casualties in war zones are a devastating consequence of armed conflicts, causing significant challenges for affected children, especially in the context of poor access to care. This study aimed to understand traumatic brain injuries (TBIs) in this high-risk population and to identify and provide information for the stakeholders, as well as to recognize severe long-term consequences and develop strategies to prevent them, thus minimizing their burden while aiding in the management of these cases. Methods We carried out a systematic literature review following PRISMA guidelines to identify publications discussing traumatic brain injuries in children in the context of war zones, and we analyzed all the collected data. Results Our study showed that head injuries were the most common casualty in war zones; male and female children were affected, and the mean age was 8-10 years. Most children were reported to be from Afghanistan, and blasts were the most common mechanism of injury. The mortality fluctuated from 3 to 47%. Conclusion There is a lack of evidence-based information regarding the characterization, approach, and management of children with TBI in conflict zones. While the world finds ways to live in peace, there is an urgency to research, train, and deploy enough specialists to these areas, if governments are serious about improving outcomes for this population.
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Affiliation(s)
| | | | - Alcy R. Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Wild H, Wren SM. High-Quality Data Collection in Low-Resource Settings: An Imperative to Improving Global Surgical Care. World J Surg 2023; 47:1397-1398. [PMID: 36995398 DOI: 10.1007/s00268-023-06986-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Sherry M Wren
- Stanford University School of Medicine, Stanford, CA, USA
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Wild H, Marfo C, Mock C, Gaarder T, Gyedu A, Wallis L, Makasa E, Hagander L, Reynolds T, Hardcastle T, Jewell T, Stewart B. Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings. World J Surg 2023; 47:1662-1683. [PMID: 36988651 DOI: 10.1007/s00268-023-06985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. METHODS We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. RESULTS The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. CONCLUSIONS While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Chris Marfo
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Charles Mock
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Tina Gaarder
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lee Wallis
- World Health Organization, Geneva, Switzerland
| | - Emmanuel Makasa
- Department of Surgery, School of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Timothy Hardcastle
- Nelson R Mandela School of Medicine, Surgery (Trauma), University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Wild H, Stewart BT, LeBoa C, Jewell T, Mehta K, Wren SM. Perioperative Risk Assessment in Humanitarian Settings: A Scoping Review. World J Surg 2023; 47:1092-1113. [PMID: 36631590 DOI: 10.1007/s00268-023-06893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND No validated perioperative risk assessment models currently exist for use in humanitarian settings. To inform the development of a perioperative mortality risk assessment model applicable to humanitarian settings, we conducted a scoping review of the literature to identify reports that described perioperative risk assessment in surgical care in humanitarian settings and LMICs. METHODS We conducted a scoping review of the literature to identify records that described perioperative risk assessment in low-resource or humanitarian settings. Searches were conducted in databases including: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, World Health Organization Catalog, and Google Scholar. RESULTS Our search identified 1582 records. After title/abstract and full text screening, 50 reports remained eligible for analysis in quantitative and qualitative synthesis. These reports presented data from over 37 countries from public, NGO, and military facilities. Data reporting was highly inconsistent: fewer than half of reports presented the indication for surgery; less than 25% of reports presented data on injury severity or prehospital data. Most elements of perioperative risk models designed for high-resource settings (e.g., vital signs, laboratory data, and medical comorbidities) were unavailable. CONCLUSION At present, no perioperative mortality risk assessment model exists for use in humanitarian settings. Limitations in consistency and quality of data reporting are a primary barrier, however, can be addressed through data-driven identification of several key variables encompassed by a minimum dataset. The development of such a score is a critical step toward improving the quality of care provided to populations affected by conflict and protracted humanitarian crises.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Barclay T Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Christopher LeBoa
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, CA, USA
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Sherry M Wren
- Stanford University School of Medicine, Stanford, CA, USA
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Zhang JK, Botterbush KS, Bagdady K, Lei CH, Mercier P, Mattei TA. Blast-Related Traumatic Brain Injuries Secondary to Thermobaric Explosives: Implications for the War in Ukraine. World Neurosurg 2022; 167:176-183.e4. [PMID: 36028113 DOI: 10.1016/j.wneu.2022.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022]
Abstract
Blast-related traumatic brain injury (bTBI) is a significant cause of wartime morbidity and mortality. In recent decades, thermobaric explosives have emerged as particularly devastating weapons associated with bTBI. With recent documentation of the use of these weapons in the war in Ukraine, clinicians and laypersons alike could benefit from an improved understanding behind the dynamic interplay between explosive weaponry, its potential for bTBI, and the subsequent long-term consequences of these injuries. Therefore, we provide a general overview of the history and mechanism of action of thermobaric weapons and their potential to cause bTBI. In addition, we highlight the long-term cognitive and neuropsychiatric sequelae following bTBI and discuss diagnostic, therapeutic, and rehabilitation strategies, with the aim of helping to guide mitigation strategies and humanitarian relief in Ukraine. Thermobaric weapons produce a powerful blast wave capable of causing bTBIs, which can be further classified from primary to quaternary injuries. When modeling the hypothetical use of thermobaric weapons in Odessa, Ukraine, we estimate that the detonation of a salvo of thermobaric rockets has the potential to affect approximately 272 persons with bTBIs. In addition to the short-term damage, patients with bTBIs can present with long-term symptoms (e.g., post-traumatic stress disorder), which incur substantial financial costs and social consequences. Although these results are jarring, history has seen radical advancements in the understanding, diagnosis, and management of bTBI. Moving forward, a better understanding of the mechanism and long-term sequelae of bTBIs could help guide humanitarian relief to those affected by the war in Ukraine.
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Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen S Botterbush
- Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Kazimir Bagdady
- Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Chi Hou Lei
- Department of Aerospace and Mechanical Engineering, School of Science and Engineering, Saint Louis University, St. Louis, Missouri, USA
| | - Philippe Mercier
- Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Tobias A Mattei
- Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
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Wild H, Reavley P, Mayhew E, Ameh EA, Celikkaya ME, Stewart B. Strengthening the emergency health response to children wounded by explosive weapons in conflict. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000443. [DOI: 10.1136/wjps-2022-000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022] Open
Abstract
The 2022 war in Ukraine has highlighted the unacceptable consequences wrought on civilians and health infrastructure by conflict. Children are among the most vulnerable of those affected and constitute an increasing percentage of non-combatants injured in conflicts globally. A disproportionate number of these injuries are caused by blast mechanisms from munitions including ‘conventional’ landmines and indiscriminate explosive weapons such as barrel bombs and improvised explosive devices. In 21st century conflict, children are no longer only accidental casualties of war, but are increasingly targeted by parties through acts such as bombing of school buses and playgrounds, conscription as child soldiers, and use as human shields. In the present viewpoint article, we review the state of pediatric blast injury studies, synthesizing current understandings of injury epidemiology and identifying gaps in research to advance the field towards a concrete agenda to improve care for this vulnerable population.
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Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq. Ann Surg 2022; 276:732-742. [PMID: 35837945 DOI: 10.1097/sla.0000000000005592] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations. BACKGROUND International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949 these standards expanded to include injured civilians. In 2001, the Global War on Terror began in Afghanistan and expanded to Iraq in 2003. US MTFs provided care to all military forces, civilians, and enemy prisoners. A thorough understanding of the scope, epidemiology, resource requirements and outcomes of civilian trauma in combat zones has not been previously characterized. METHODS Retrospective cohort analysis of the Department of Defense Trauma Registry from 2005-2019. Inclusion criteria were civilians and non-NATO coalition personnel (NNCP) with traumatic injuries treated at MTFs in Afghanistan and Iraq. Patient demographics, mechanism of injury, resource requirements, procedures, and outcomes were categorized. RESULTS A total of 29,963 casualties were eligible from the Registry. There were 16,749 (55.9%) civilians and 13,214 (44.1%) NNCP. The majority of patients were age >13 years [26,853 (89.6%)] and male [28,000 (93.4%)]. Most injuries were battle-related: 12,740 (76.1%) civilians and 11,099 (84.0%) NNCP. Penetrating trauma was the most common cause of both battle and nonbattle injuries: 12,293 (73.4%) civilian and 10,029 (75.9%) NNCP. Median injury severity score (ISS) was 9 in each cohort with ISS scores ≥ 25 in 2,236 (13.4%) civilians and 1,398 (10.6%) NNCP. Blood products were transfused to 35% of each cohort: 5,850 civilians received a transfusion with 2,118 (12.6%) of them receiving ≥10 units; 4,590 NNCPs received a transfusion with 1,669 (12.6%) receiving ≥ 10 units. MTF mortality rates were civilians 1,263 (7.5%) and NNCP 776 (5.9%). Interventions, both operative and non-operative, were similar between both groups. CONCLUSIONS In accordance with International Humanitarian Law, as well as the US military's medical rules of eligibility, civilians injured in combat zones were provided the same level of care as non-NATO Coalition Personnel. Injured civilians and NNCP had similar mechanisms of injury, injury patterns, transfusion needs, and ISS. This analysis demonstrates resource equipoise in trauma care delivered to civilians and NNCP. Hospitals in combat zones must be prepared to manage large numbers of civilian casualties with significant human and material resources allocated to optimize survival. The provision of humanitarian trauma care is resource-intensive, and these data can be used to inform planning factors for current or future humanitarian care in combat zones.
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Lava SAG, de Luca D, Milani GP, Leroy P, Ritz N, de Winter P. Please stop the Russian-Ukrainian war - children will be more than grateful. Eur J Pediatr 2022; 181:2183-2185. [PMID: 35298706 PMCID: PMC8927752 DOI: 10.1007/s00431-022-04444-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sebastiano A G Lava
- Paediatric Cardiology Unit, Department of Paediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniele de Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Piet Leroy
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nicole Ritz
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital, University of Basel, Basel, Switzerland
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands.
- KU Leuven Department of Development and Regeneration, Leuven, Belgium.
- KU Leuven Child & Youth Institute, Leuven, Belgium.
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