ArticlePLOS global public health2026
Epidemiology of civilian patients with acute conflict-related extremity injuries sustained in Syria and Iraq.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02444598 (A Prospective, Randomized, Controlled Trial of Negative-pressure Wound Therapy Use in Conflict-related Extremity Wounds), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Prospective, Randomized, Controlled Trial of Negative-pressure Wound Therapy Use in Conflict-related Extremity Wounds (VACoCREW Trial)
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Most casualties of modern conflict are civilian, and extremity injuries are the most frequent injury type. However, prospectively epidemiological data on civilians with conflict-related extremity injuries remain scarce. We conducted a multi-site observational study of prospectively collected data from a randomized controlled trial on negative pressure wound therapy. The present study disregarded treatment modality and described adults with acute conflict-related extremity wounds not suitable for primary closure treated at two civilian trauma hospitals in Erbil, Iraq and Ar Ramtha, Jordan from 2015 until 2018. A total of 165 patients were included. Median age was 28 years (interquartile range [IQR] 21-34); 155 (94%) were male. Gunshot injuries were most common (100 [60%] patients), followed by blast injuries (63 [38%] patients). Fractures occurred in 93 (57%) patients, including 74 (45%) open fractures, of which 16 (22%) had wound infections, defined as purulent discharge. Concomitant injuries occurred in 43 (26%) patients, including fractures at a site other than the studied wound, penetrating abdominal injuries, and abdominal solid-organ or gastrointestinal injuries. Bleeding requiring transfusion affected 56 (35%) patients. Median hospital stay was 10 days (IQR 5-37), and one (1%) patient died. Patients treated in Ar Ramtha had more wounds, more concomitant injuries, more blast injuries, longer times to wound closure, and longer hospital stays than patients treated in Erbil. Fractures were common, including open fractures, and bleeding requiring transfusion was frequent. Infection among patients with open fractures was comparatively uncommon, although comparison with other settings is limited by differences in case mix and organization of care. Low in-hospital mortality likely reflects selection of patients who survived to reach hospital. By providing standardized prospective data on an underreported civilian conflict-injury population, this study may inform public health planning for surgical capacity, blood supply, wound care, and hospital resources in similar conflict-affected settings.
trial registrationNCT02444598.
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