title: Penetrating abdominal injuries during the Syrian war: Patterns and factors affecting mortality rates.
abstract: BACKGROUND
  A large number of innocent Syrians were injured or killed during the years of war. This retrospective study investigates the differences in patterns of injury and factors affecting the mortality rate in 324 patients coming to Damascus Hospital with penetrating abdominal trauma, and illustrates the difficulties of diagnosis and decision making in crisis situations.
  
  
  METHODS
  A retrospective study was registered from patient's records between October 2012 and June 2013 in Damascus Hospital. All victims were injured either by explosions or gunshots.
  
  
  RESULTS
  A total of 325 patients: 183 by explosion; 56.3%, 141 by gunshot; 43.3%, and one patient by other means; 0.3% were reviewed. The study focused on the two large groups with a total of 324 patients. Males were predominant (82.1%; n=266) and the majority of patients were between 19 and 35 years old. Patients suffering from multi abdominal organ injury were more common in gunshot group (n=72, 51.1%) compared to the explosion group (n=83, 45.3%). 264 patients (81.5%) underwent surgical operations and only 22 (8.3%) had normal laparotomy. The inpatient mortality rate was (17.0%; n=55), and there was no difference in mortality rate between the two groups. More than the half of deaths (n=42; 76.4%) had a P.A.T.I score≥25 where the death rate was 35.6% which is higher compared to 6.3% in those with a P.A.T.I<25. In the ICU 33 patients died, of these (87.9%; n=29) died after immediate admission to the ICU which is higher compared with a later admission (12.1%; n=4). The need for massive blood transfusion affected the mortality rate.
  
  
  CONCLUSIONS
  Efforts must be directed toward training of medical staff to deal with crisis incidents. The need for massive blood transfusion and ICU admissions can affects mortality. P.A.T.I was found to be an effective predictor of mortality. Clinical experience in this field can produce better health care and faster judgments.
authors.affiliation: Department of Surgery, Damascus Hospital, Damascus, Syria. Electronic address: Shawki1290@gmail.com.
authors.forename: Shawqi
authors.initials: S
authors.lastname: Arafat
authors.affiliation: Department of Surgery, Damascus Hospital, Damascus, Syria; Department of Surgery, Syrian Private University (SPU), Damascus, Syria. Electronic address: drsabekb@gmail.com.
authors.forename: Mhd Belal
authors.initials: MB
authors.lastname: Alsabek
authors.affiliation: Faculty of Medicine, Syrian Private University, Damascus, Syria. Electronic address: mousaa2711@gmail.com.
authors.forename: Mousa
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Faculty of Medicine, Syrian Private University, Damascus, Syria. Electronic address: iman.arabhamo@gmail.com.
authors.forename: Iman
authors.initials: I
authors.lastname: Hamo
authors.affiliation: Faculty of Medicine, Syrian Private University, Damascus, Syria. Electronic address: eskander.munder@gmail.com.
authors.forename: Eskander
authors.initials: E
authors.lastname: Munder
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005107:Explosions; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013593:Syria / Q000453:epidemiology; D014194:Traumatology / Q000193:education; D014857:Warfare; D014948:Wounds, Gunshot / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
keywords: Abdominal trauma; Explosions; Gunshots; Mortality factors; Syria; War injuries