• Login
    View Item 
    •   Home
    • 1 Published Research and Commentary
    • Surgery
    • View Item
    •   Home
    • 1 Published Research and Commentary
    • Surgery
    • View Item
    Jan 17, 2021
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of MSFTitleAuthorsSubjectsPublisherJournalThis CollectionTitleAuthorsSubjectsPublisherJournal

    Negative pressure wound therapy versus standard treatment in patients with acute conflict-related extremity wounds: a pragmatic, multisite, randomised controlled trial

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    Alga et al 2020 Negative pressure ...
    Size:
    369.2Kb
    Format:
    PDF
    Download
    Authors
    Älgå, A
    Haweizy, R
    Bashaireh, K
    Wong, S
    Lundgren, KC
    von Schreeb, J
    Malmstedt, J
    Issue Date
    2020-03-01
    Submitted date
    2020-07-05
    
    Metadata
    Show full item record
    Journal
    The Lancet. Global Health
    Abstract
    Background: In armed conflict, injuries among civilians are usually complex and commonly affect the extremities. Negative pressure wound therapy (NPWT) is an alternative to standard treatment of acute conflict-related extremity wounds. We aimed to compare the safety and effectiveness of NPWT with that of standard treatment. Methods: In this pragmatic, randomised, controlled superiority trial done at two civilian hospitals in Jordan and Iraq, we recruited patients aged 18 years or older, presenting with a conflict-related extremity wound within 72 h after injury. Participants were assigned (1:1) to receive either NPWT or standard treatment. We used a predefined, computer-generated randomisation list with three block sizes. Participants and their treating physicians were not masked to treatment allocation. The primary endpoint was wound closure by day 5. The coprimary endpoint was net clinical benefit, defined as a composite of wound closure by day 5 and freedom from any bleeding, wound infection, sepsis, or amputation of the index limb. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT02444598, and is closed to accrual. Findings: Between June 9, 2015, and Oct 24, 2018, 174 patients were randomly assigned to either the NPWT group (n=88) or the standard treatment group (n=86). Five patients in the NPWT group and four in the standard treatment group were excluded from the intention-to-treat analysis. By day 5, 41 (49%) of 83 participants in the NPWT group and 49 (60%) of 82 participants in the standard treatment group had closed wounds, with an absolute difference of 10 percentage points (95% CI -5 to 25, p=0·212; risk ratio [RR] 0·83, 95% CI 0·62 to 1·09). Net clinical benefit was seen in 33 (41%) of 81 participants in the NPWT group and 34 (44%) of 78 participants in the standard treatment group, with an absolute difference of 3 percentage points (95% CI -12 to 18, p=0·750; RR 0·93, 95% CI 0·65 to 1·35). There was one in-hospital death in the standard treatment group and none in the NPWT group. The proportion of participants with sepsis, bleeding leading to blood transfusion, and limb amputation did not differ between groups. Interpretation: NPWT did not yield superior clinical outcomes compared with standard treatment for acute conflict-related extremity wounds. The results of this study not only question the use of NPWT, but also question the tendency for new and costly treatments to be introduced into resource-limited conflict settings without supporting evidence for their effectiveness. This study shows that high-quality, randomised trials in challenging settings are possible, and our findings support the call for further research that will generate context-specific evidence. Funding: The Stockholm County Council, the Swedish National Board of Health and Welfare, and Médecins Sans Frontières.
    Publisher
    Elsevier
    URI
    http://hdl.handle.net/10144/619681
    DOI
    10.1016/S2214-109X(19)30547-9
    PubMed ID
    32087175
    Type
    Article
    Other
    Other
    Other
    Language
    en
    EISSN
    2214-109X
    ae974a485f413a2113503eed53cd6c53
    10.1016/S2214-109X(19)30547-9
    Scopus Count
    Collections
    Surgery

    entitlement

    Related articles

    • Negative-Pressure Wound Therapy Versus Standard Treatment of Adult Patients With Conflict-Related Extremity Wounds: Protocol for a Randomized Controlled Trial.
    • Authors: Älgå A, Wong S, Haweizy R, Conneryd Lundgren K, von Schreeb J, Malmstedt J
    • Issue date: 2018 Nov 26
    • Negative pressure wound therapy for surgical wounds healing by primary closure.
    • Authors: Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, Stankiewicz M, Chaboyer WP
    • Issue date: 2019 Mar 26
    • Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention.
    • Authors: Webster J, Scuffham P, Stankiewicz M, Chaboyer WP
    • Issue date: 2014 Oct 7
    • Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention.
    • Authors: Webster J, Scuffham P, Sherriff KL, Stankiewicz M, Chaboyer WP
    • Issue date: 2012 Apr 18
    • Negative pressure wound therapy: an evidence-based analysis.
    • Authors: Medical Advisory Secretariat.
    • Issue date: 2006
    DSpace software (copyright © 2002 - 2021)  DuraSpace
    Quick Guide | Contact Us
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.