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

Ron Birnbaum; Rudy Bitton; Romain Pirracchio; Anne-Laure Féral-Pierssens; Anne-Laure Constant; Clément Dubost; Benjamin Chousterman; Thomas Lescot; Brice Lortat-Jacob; Anatole Harrois; Paer-Selim Abback; Anissa Belbachir; Emmanuel Basto; Yves Castier; Philippe Laitselart; Pierre Carli; Frédéric Lapostolle; Jean Pierre Tourtier; Matthieu Langlois; Mathieu Raux; Roman Mounier; TRAUMABASE Group

doi:10.1016/j.accpm.2021.100908

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

Anaesth Crit Care Pain Med. 2021 Aug;40(4):100908. doi: 10.1016/j.accpm.2021.100908. Epub 2021 Jun 24.

Authors

Ron Birnbaum¹, Rudy Bitton², Romain Pirracchio³, Anne-Laure Féral-Pierssens⁴, Anne-Laure Constant⁵, Clément Dubost⁶, Benjamin Chousterman⁷, Thomas Lescot⁸, Brice Lortat-Jacob⁹, Anatole Harrois¹⁰, Paer-Selim Abback¹¹, Anissa Belbachir¹², Emmanuel Basto¹³, Yves Castier¹⁴, Philippe Laitselart¹⁵, Pierre Carli¹⁶, Frédéric Lapostolle¹⁷, Jean Pierre Tourtier¹⁸, Matthieu Langlois¹⁹, Mathieu Raux²⁰, Roman Mounier²¹; TRAUMABASE Group

Affiliations

¹ Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France. Electronic address: robirn8@hotmail.com.
² Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
³ Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA.
⁴ Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
⁵ Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁶ Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France.
⁷ Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁹ Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁰ Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
¹¹ Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France.
¹² Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹³ Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁴ Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁵ Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France.
¹⁶ SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France.
¹⁷ SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France.
¹⁸ Fire Brigade of Paris, Paris, France.
¹⁹ RAID Médical Service, Bièvres, France.
²⁰ Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
²¹ Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France.

PMID: 34174462
DOI: 10.1016/j.accpm.2021.100908

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.

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

MeSH terms

Abdominal Injuries*
Humans
Incidence
Injury Severity Score
Paris / epidemiology
Retrospective Studies
Risk Factors