Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries - 01/09/21

Doi : 10.1016/j.accpm.2021.100908

Ron Birnbaum ^a,⁎ , Rudy Bitton ^a, Romain Pirracchio ^b, Anne-Laure Féral-Pierssens ^c, Anne-Laure Constant ^d, Clément Dubost ^e, Benjamin Chousterman ^f, Thomas Lescot ^g, Brice Lortat-Jacob ^h, Anatole Harrois ⁱ, Paer-Selim Abback ^j, Anissa Belbachir ^k, Emmanuel Basto ^l, Yves Castier ^m, Philippe Laitselart ⁿ, Pierre Carli ^o, Frédéric Lapostolle ^p, Jean Pierre Tourtier ^q, Matthieu Langlois ^r, Mathieu Raux ^s,^t, Roman Mounier ^a,^u
The TRAUMABASE Group
^a Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
^b Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
^c Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
^d Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^e Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France
^f Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^g Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^h Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
ⁱ Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
^j Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
^k Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^l Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^m Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
ⁿ Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France
^o SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France
^p SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France
^q Fire Brigade of Paris, Paris, France
^r RAID Médical Service, Bièvres, France
^s Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^t Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
^u Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France

^⁎Corresponding author at: Anaesthesia and Surgical Intensive Care Department, Henri Mondor University Hospital, 51, Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.Anaesthesia and Surgical Intensive Care DepartmentHenri Mondor University Hospital51, Avenue du Maréchal de Lattre de TassignyCréteil94000France

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Abstract

Background

We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris.

Methods

This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis.

Results

Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9–20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014–1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000–1.012], p = 0.041) were the only risk factors identified.

Conclusion

We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.

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Keywords : High–energy ammunition injury, Wound infection, Combat-related injury, Terrorist attack, Risk factor

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HEAI-associated wound infections

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Vol 40 - N° 4

Article 100908- août 2021 Retour au numéro

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Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries - 01/09/21

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