Barth Cornelia Anne, Wladis Andreas, Blake Catherine, Bhandarkar Prashant, Aebischer Perone Sigirya, O'Sullivan Cliona
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
BMJ Open. 2021 Dec 1;11(12):e049533. doi: 10.1136/bmjopen-2021-049533.
Limb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries.
A retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations.
Five countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment.
All PwA newly attending rehabilitation.
Data for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001).
Young age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.
由于冲突、事故和糖尿病管理不善，在脆弱环境中肢体截肢发生率特别高。本研究旨在分析：（1）各类后天性截肢患者（PwA）的人口统计学和截肢特征；（2）五个冲突国家和冲突后国家中截肢与首次获得康复治疗之间的时间间隔。
一项回顾性观察研究，分析创伤性截肢和非创伤性截肢患者在人口统计学和临床因素以及获得康复治疗时间方面的差异。
全球红十字国际委员会数据库中后天性截肢患者数量最多的五个国家（阿富汗、柬埔寨、伊拉克、缅甸、苏丹）。对2009年至2018年清理并合并的数据按性别、截肢和登记时的年龄、截肢原因、合并情况及解剖部位、生活环境进行汇总。
所有新接受康复治疗的后天性截肢患者。
纳入了28446人的数据（4329人（15.2%）为女性）。大多数为创伤性截肢（73.4%，20890例）；其中，48.6%（13801例）与冲突有关。男性和女性创伤性截肢的平均年龄分别为26.9岁和24.1岁；非创伤性截肢的平均年龄分别为49.1岁和45.9岁。创伤性和非创伤性原因导致的截肢在年龄上的性别差异具有统计学意义（p<0.001，p=0.003）。创伤性截肢患者截肢与康复之间的平均延迟时间为8.2年，显著高于非创伤性截肢患者的平均3年（p<0.001）。
创伤性和非创伤性截肢患者的低龄表明战争和脆弱的卫生系统对社会具有毁灭性影响。截肢与康复之间的长时间延迟揭示了需求与资源的不匹配。对于脆弱环境中的康复服务提供者而言，管理各种原因、年龄、性别及其他情况的后天性截肢患者的多样性是一项艰巨任务。建议加强初级医疗保健、外科和康复服务之间的协作，优先安排康复治疗并增加资源投入，以确保后天性截肢患者能够获得充分的综合康复护理。
