Analysis of 193,618 trauma patient presentations in war-affected Syria from July 2013 to July 2015

IntroductionSince 2011, the Syrian war has produced a mounting toll in terms of deaths and displaced persons. We present an analysis of demographic and temporal patterns of trauma patient presentations to Syrian hospitals in non-governmental, non-Islamic State (NGNI) regions from 2013 - 2015. MethodsWe analyzed an administrative dataset of patient presentations to 95 NGNI Syrian hospitals in regions outside of Syrian government control from July 2013 - July 2015. Descriptive analysis of this secondary data is reported and logistic regression was performed to assess for factors associated with inpatient mortality. Results193,618 trauma patients presented to 95 NGNI hospitals from July 2013 - July 2015 (154,225 male, 79.7%; 39,393 female, 20.4%). Age information was complete for 160,237 encounters (82.8%): 0-2y: 8,257 (4.3%), 3-12y: 24,199 (12.5%), 13-18y: 22,482 (11.6%), 19-60y: 100,553 (51.9%), and elders over 60 years: 4,746 (2.5%). 59,387 patients were admitted (Ward 57,625; ICU 1,762) for an average length of stay of 3.80 days. There were 2,694 inpatient deaths (4.5% of admitted) and 4,758 patients (8.0%) required transfer to another facility for definitive care. Shrapnel (81,946; 42.3%) and blunt/crush injuries (71,477; 36.9%) were dominant injury mechanisms with an increasing proportion of these injuries over time. Inpatient mortality was most associated with extremes of age (age less than 2 aOR 2.92; age greater than 60 aOR 2.48), penetrating chest trauma (gunshot-chest aOR 6.03) and neurotrauma (blast-head aOR 13.42; blast-spine aOR 11.31; gunshot-head aOR 10.07; shrapnel-head aOR 6.34). Civilians presentations increased from 20% at start of data collection to a peak of 50% in June 2015. ConclusionThe Syrian war has resulted in large volumes of trauma patients and significant mortality at NGNI Syrian hospitals. Mortality was most associated with neurotrauma and penetrating chest trauma. There was an increasing trend over time towards blunt/crush and shrapnel injuries consistent with the transition to the widespread use of aerial bombardment with resultant explosions and building collapse. Civilians including children and the elderly represent high proportions of the injured in NGNI Syrian hospitals. Additional work is needed to improve documentation of clinical service and to assess outcomes of care to improve quality of services provided to Syrian war trauma patients.