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Neurotrauma in the Syrian War: analysis of 41,143 cases from July 2013–July 2015

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Abstract

Introduction

Despite nearly a decade of conflict, little is known about trauma and injuries resulting from the Syrian war.

Methods

Secondary analysis was conducted of an administrative dataset of patient presentations to a network of 95 war-affected hospitals in Syria from July 2013–July 2015. Logistic regression was performed to identify factors associated with mortality of neurotrauma patients.

Results

Of 193,618 overall trauma presentations, 41,143 were for neurotrauma (37,410 head trauma, 1407 spinal trauma, and 3133 peripheral nervous system). There were 31,359 males (76.2%) and 9784 females (23.8%). Males aged 19–30 years (10,113; 24.6%) were the largest single demographic group. Presumed non-combatants including females, elders, and children under 13 years (16,214; 39.4%) were the largest group of patients overall. There were 16,881 (41.0%) presentations with blunt injuries (blunt/crush injuries) and 21,307 (51.8%) patients with penetrating injuries (shrapnel, cut, gunshot). A total of 36,589 patients (89.6%) were treated and discharged from the hospital, 2100 (5.1%) were transferred to another facility, 2050 patients (5.0%) died in-hospital, 26 remained in the hospital (0.1%), and 108 (0.3%) had unknown disposition. The median length of hospital stay was 1 day. There were 4034 (9.7%) neurosurgical procedures documented. Patients with combined neurotrauma and general trauma suffered 30 times higher mortality than neurotrauma alone (aOR: 30.4; 95% CI: 20.8–44.2, p < 0.0001).

Conclusion

The Syrian War resulted in large volumes of neurotrauma patients. Presumed non-combatants comprised 39.4% of patients who survived to treatment at a facility. Further study is needed on long-term needs of neurotrauma victims of the Syrian war.

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References

  1. Nasser R, Mehchy Z, Jebaie JA-K, Marzouk N, Saba K (2016) Syria - confronting fragmentation: impact of Syrian crisis report. In: Research SCfP (ed) London

  2. UNHCR (2020) Syria Regional Refugee Response. https://data2.unhcr.org/en/situations/syria. Accessed 25 Oct 2020

  3. Elamein M, Bower H, Valderrama C et al (2017) Attacks against health care in Syria, 2015–16: results from a real-time reporting tool. Lancet 390(10109):2278–2286. https://doi.org/10.1016/S0140-6736(17)31328-4

    Article  PubMed  Google Scholar 

  4. Patel P, Gibson-Fall F, Sullivan R, Irwin R (2017) Documenting attacks on health workers and facilities in armed conflicts. Lancet Glob Health 95(1):79–81. https://doi.org/10.2471/BLT.15.168328

    Article  Google Scholar 

  5. Safeguarding Health in Conflict Coalition. IMPUNITY MUST END: attacks on health in 23 countries in conflict in 2016. Washington; 2017:84.

  6. Ri S, Blair AH, Kim CJ, Haar RJ (2019) Attacks on healthcare facilities as an indicator of violence against civilians in Syria: an exploratory analysis of open-source data. PLoS ONE 14(6):e0217905. https://doi.org/10.1371/journal.pone.0217905

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Alahdab F, Omar MH, Alsakka S, Al-Moujahed A, Atassi B (2014) Syrians’ alternative to a health care system: “field hospitals.” Avicenna J Med 4(3):51–52. https://doi.org/10.4103/2231-0770.133329

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mowafi H, Hariri M, Alnahhas H et al (2016) Results of a nationwide capacity survey of hospitals providing trauma care in war-affected Syria. JAMA Surg. https://doi.org/10.1001/jamasurg.2016.1297

    Article  PubMed  Google Scholar 

  9. El Hajj AY, Beveridge J, Chan M et al (2019) Devastating neurologic injuries in the Syrian war. Neurol Clin Pract 9(1):9–15. https://doi.org/10.1212/CPJ.0000000000000556

    Article  Google Scholar 

  10. Guha-Sapir D, Rodriguez-Llanes JM, Hicks MH et al (2015) Civilian deaths from weapons used in the Syrian conflict. BMJ: Br Med J 351. https://doi.org/10.1136/bmj.h4736

  11. Guha-Sapir D, Schlüter B, Rodriguez-Llanes JM, Lillywhite L, Hicks MH-R (2018) Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011&#x2013;16. Lancet Global Health 6(1):e103-e110. https://doi.org/10.1016/S2214-109X(17)30469-2

  12. Lindquist LK, Love HC, Elbogen EB (2017) Traumatic brain injury in Iraq and Afghanistan veterans: new results from a national random sample study. J Neuropsych Clin N 29(3):254–259. https://doi.org/10.1176/appi.neuropsych.16050100

    Article  Google Scholar 

  13. Jamous MA (2019) Outcome of craniocerebral penetrating injuries: experience from the Syrian war. J Neurol Surg A Cent Eur Neurosurg 80(5):345–352. https://doi.org/10.1055/s-0039-1683878

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the health workers who at great personal risk continue to provide life-saving care for the sick and injured inside Syria and to the data collection team who similarly faced threats to their safety as they collected the data that informed this study. In addition, the authors would like to recognize the 95 hospital directors who provided access to their data and the partner organizations including Syrian American Medical Society (SAMS), Physicians Across Continents (PAC), Syrian Expatriate Medical Association (SEMA), Sham Humanitarian Fund, and all the other members of the hospital committee and the independent hospitals inside Syria whose cooperation has enabled this report. Finally, the authors would like to express our thanks to Dr. Monzer Yazji for helping to facilitate this research collaboration.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The funding of data collection for the underlying administrative dataset was supplied by the Union of Medical Care and Relief Organizations (UOSSM). UOSSM had no role in the design, analysis or interpretation of the data, the writing of this manuscript, nor in the decision to publish.

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Author notes

  1. Nida Fatima and Hani Mowafi contributed equally as first authors to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA

    Nida Fatima

  2. Department of Emergency Medicine, Yale University, New Haven, CT, USA

    Hani Mowafi

  3. Health Information Systems Unit, Idleb Health Directorate, Idleb, Syria

    Mahmoud Hariri

  4. Union of Medical Care and Relief Organizations (UOSSM), Gaziantep, Turkey

    Mahmoud Hariri

  5. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Houssam Alnahhas

  6. Union of Medical Care and Relief Organizations – Canada (UOSSM - Canada), Mississauga, ON, Canada

    Anas Al-Kassem

  7. Department of Neurology, University of Alberta, Edmonton, Canada

    Maher Saqqur

  8. Department of Neuroscience/MSK Trillium Hospital/Institute for Better Health, University of Toronto at Mississauga, Mississauga, ON, Canada

    Maher Saqqur

Authors
  1. Nida Fatima
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  2. Hani Mowafi
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  3. Mahmoud Hariri
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  4. Houssam Alnahhas
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Corresponding author

Correspondence to Nida Fatima.

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Conflict of interest

The authors would like to state that they have no financial conflicts to disclose. Four of the authors have worked inside Syria as physicians providing direct medical care (MH, HA, AA, and MS).

Ethics approval

The study was approved by the Union of Medical Care and Relief Organization (UOSSM) IRB.

Informed consent

The paper was exempted from informed consent as the anonymous retrospective patient information was presented in this study.

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Fatima, N., Mowafi, H., Hariri, M. et al. Neurotrauma in the Syrian War: analysis of 41,143 cases from July 2013–July 2015. Neurol Sci 43, 3769–3774 (2022). https://doi.org/10.1007/s10072-022-05878-3

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  • DOI: https://doi.org/10.1007/s10072-022-05878-3

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