Article Text
Abstract
Background Neurovascular trauma injuries in war and conflict zones pose unique challenges to healthcare systems, yet literature on this topic is scarce, particularly in regions like Syria. We conducted a systematic review and shared our experience from three major healthcare institutions in Syria to illuminate the clinical management and outcomes of neurovascular trauma injuries in these contexts.
Methods Our systematic review identified a limited number of studies addressing neurovascular trauma injuries in war and conflict areas. Additionally, we retrospectively analyzed data from three major healthcare institutions in Syria, focusing on demographics, injury characteristics, management strategies, and outcomes of patients with neurovascular trauma injuries.
Results The systematic review revealed a paucity of literature specifically addressing neurovascular trauma injuries in war and conflict areas. Among the identified studies, only five directly investigated this topic, with varying degrees of detail. From our retrospective analysis of data from three major healthcare institutions in Syria, we identified a cohort of 87 patients with neurovascular trauma injuries over a five-year period. Predominantly male (78%) with a median age of 34 years (range 18–65), the most common mechanisms of injury were gunshot wounds (62%) and explosive blast injuries (28%). Acute intracranial hemorrhage was present in 45% of cases, with associated vascular injuries observed in 33% of patients. Surgical intervention was required in 60% of cases, including craniotomy for hematoma evacuation and vascular repair procedures. The overall mortality rate was 22%, with poor neurological outcomes observed in 40% of survivors. Furthermore, our analysis identified predictors of favorable and unfavorable outcomes in patients with neurovascular trauma injuries. Factors associated with favorable outcomes included prompt surgical intervention (adjusted OR 2.94, 95% CI 1.68–5.15), absence of associated vascular injuries (adjusted OR 3.12, 95% CI 1.78–5.46), and younger age (adjusted OR 0.96, 95% CI 0.93–0.99). Conversely, predictors of unfavorable outcomes included delayed presentation to healthcare facilities (adjusted OR 4.21, 95% CI 2.43–7.30), presence of acute intracranial hemorrhage (adjusted OR 3.75, 95% CI 2.16–6.50), and need for multiple surgical interventions (adjusted OR 5.82, 95% CI 3.36–10.08).
Conclusions Neurovascular trauma injuries in war and conflict areas, such as Syria, present significant clinical challenges with high morbidity and mortality rates. Despite limited literature, our experience underscores the importance of prompt recognition, appropriate surgical intervention, and multidisciplinary management in optimizing outcomes for patients with neurovascular trauma injuries in these settings. Keywords: Neurovascular trauma, war, conflict, Syria, systematic review, outcomes.
Disclosures R. Abo Kasem: None. H. Rafka: None. H. Almorawed: None. M. Al Khalaf: None. L. Abo Dest: None. A. Rehawi: None. A. Bayram: None. G. Bdeoui: None.