A multicentre cross-sectional survey study on acute wound classification in the emergency department and its interobserver variability.

Annually, a vast number of patients visits the emergency department for acute wounds. Many wound classification systems exist, but often these were not originally designed for acute wounds. This study aimed to assess the most frequently used classifications for acute wounds in the Netherlands and the interobserver variability of the Gustilo Anderson wound classification (GAWC) and Red Cross wound classification (RCWC) in acute wounds. This multicentre cross-sectional survey study employed an online oral questionnaire. We contacted emergency physicians from eleven hospitals in the south-eastern part of the Netherlands and identified the currently applied classifications. Participants classified ten fictitious wounds by applying the GAWC and RCWC. Afterwards, they rated the user-friendliness of these classifications. We examined the interobserver variability of both classifications using a Fleiss' kappa analysis, with a subdivision in RCWC grades and types representing wound severity and injured tissue structures. The study included twenty emergency physicians from eight hospitals. Fifty percent of the participants reported using a classification for acute wounds, mostly the GAWC. The interobserver variability of the GAWC (κ = 0.46; 95% CI 0.44-0.49) and RCWC grades (κ = 0.56; 95% CI 0.53-0.59) was moderate, and it was good for the RCWC types (κ = 0.69; 95% CI 0.66-0.73). Participants considered both classifications helpful for acute wound assessment when the emergency physician was less experienced, despite a moderate user-friendliness. The GAWC was only of additional value in wounds with fractures, whereas the RCWC's additional value in acute wound assessment was independent of the presence of a fracture. Emergency physicians are reserved to use a classification for acute wound assessment. The interobserver variability of the GAWC and RCWC in acute wounds is promising, and both classifications are easy to apply. However, their user-friendliness is moderate. It is recommended to apply the GAWC to acute wounds with underlying fractures and the RCWC to major traumatic injuries. Awareness should be raised of existing wound classifications, specifically among less experienced healthcare professionals.

Using the Red Cross wound classification to predict treatment needs in children with conflict-related limb injuries: a retrospective database study.

BACKGROUND: The International Committee of the Red Cross (ICRC) implemented the Red Cross wound classification (RCWC) to quickly assess the severity of a wound in conflict settings. A subdivision into wound grades derived from the RCWC consists of grades 1, 2, and 3, and represents low, major, and massive energy transfer, respectively, to the injured tissue. The aim of this observational study is to assess whether the Red Cross wound grade of a pediatric patient's wound correlates with patient outcomes. METHODS: All pediatric patients (age < 15 years) treated in an ICRC hospital between 1988 and 2014 for conflict-related penetrating extremity injuries were retroactively included. Correlations were assessed between wound grades and number of surgeries, blood transfusions, days hospitalized, and mortality. Stratification analyses were performed to evaluate potential effect modifiers. RESULTS: The study included 2463 pediatric patients. Pediatric patients with a higher wound grade received significantly more surgeries (grade 1 median 2; grade 3 median 3), more blood transfusions (grades 1 and 3 received 33.9 and 72.2 units per 100 patients, respectively), and were hospitalized longer (grade 1 median 15; grade 3 median 40 days). Mortality rates did not significantly differ. Stratification analyses did not reveal effect modifiers for the association between wound grades and patient outcomes. CONCLUSION: The Red Cross wound grade of a pediatric patient's extremity wound correlates independently with treatment needs. This simple wound grading system could support clinical decision-making and should be integrated into the clinical assessment of weapon-wounded pediatric patients in conflict settings.

Global surgery for paediatric casualties in armed conflict.

Background: Understanding injury patterns specific for paediatric casualties of armed conflict is essential to facilitate preparations by organizations that provide medical care in conflict areas. The aim of this retrospective cohort study is to identify injury patterns and treatment requirements that are specific for paediatric patients in conflict zones. Methods: Characteristics of children (age < 15 years) treated in medical facilities supported by the International Committee of the Red Cross (ICRC) between 1988 and 2014 in Kabul, Kao-i-Dang, Lokichogio, Kandahar, Peshawar, Quetta and Goma were analysed; patient characteristics were compared between treatment facilities and with those of adult patients (age ≥ 15 years). Results: Of the patients listed in the database, 15% (5843/38,088) were aged < 15 years. The median age was 10 years (IQR 6-12); 75% (4406/5843) were male. Eighty-six percent (5012/5,843) of the admitted children underwent surgery, with a median of 2 surgeries per patient (IQR 1-3). When compared with adult patients, children were more frequently seen with fragment injuries, burns and mine injuries; they had injuries to multiple body regions more often and had higher in-hospital mortality rates. Conclusions: Children more often sustained injuries to multiple body regions and had higher in-hospital mortality than adults. These findings could have implications for how the ICRC and other organizations prepare personnel and structure logistics to meet the treatment needs of paediatric victims of armed conflicts.