{"doi":"10.1002/wjs.12644","title":"Context‐Appropriate Clinical Practice Guidelines for the Care of Explosive Ordnance Casualties in Low‐Resource Settings","abstract":"Between 2022 and 2024, civilian fatalities from explosive weapons (EW) increased by 122%, attributable to the extensive use of EW in conflicts globally, including Ukraine, Gaza, Syria, Sudan, and others less publicized such as the Sahel [1, 2]. EW are indiscriminate by nature. In conflicts characterized by their use, the majority of casualties are civilian. The protracted nature of modern armed conflict, increasing complexity in involvement of nonstate armed groups, and disregard for international humanitarian law in combination with the use of EW in populated areas severely strains local healthcare infrastructure, limiting the quality of timely trauma care for local casualties [3]. Illustrating this disparity, the mortality rate among civilian victims of EW is approximately 38%, which is several times higher than that observed in high-resource trauma systems [4]. Trauma care advances in high-resource systems (military or civilian) have not yet systematically reached care practices in low-resource conflict settings (LRCS). Among these advances are Clinical Practice Guidelines (CPGs), which have been described as the “backbone” of the Joint Trauma System (JTS) performance improvement program [5]. The JTS, under the US Department of Defense (DoD), aims to reduce variability in trauma care practice through developing and implementing CPGs system-wide, with topics ranging from antibiotics to drowning management. Targeted toward deployed military medical professionals caring for injured service members, CPGs have since often been used in civilian care; the DoD itself recognized that “standards and recommendations have found their way into the civilian medical communities” [5]. The CPG development process and author teams being exclusively from high-resource militaries The demographic differences between civilian and military casualties Differences in resources available to humanitarian versus military healthcare professionals, including limited evacuation abilities This editorial perspective elucidates these differences, illustrating the need for context-appropriate CPGs, and provide an overview of a potential solution: new CPGs being developed for local casualty care by the Explosive Weapons Trauma Care Collective (EXTRACCT); the development process details are included here as Online Resource 1. EXTRACCT is a multisectoral initiative to reduce preventable death and disability among EW victims in LRCS [7]. Widespread use of CPGs designed specifically for local casualties in LRCS holds potential to improve the quality of care provided to EW victims. The development process and objectives of JTS versus EXTRACCT CPGs vary slightly. The former are based on DoD Trauma Registry data, after action reports and predominantly military patient records. JTS CPGs, designed for implementation in well-resourced MTF by military medical professionals of various clinical backgrounds, aim to “remove medical practice variations and save lives” [5]. The EXTRACCT CPGs have similar goals, but aim additionally for embedded minimum casualty data requirements for “longitudinal monitoring of patient outcomes”, given the lack of system-wide local casualty registries in LRCS. In addition to content derived from JTS CPGs, EXTRACCT CPGs incorporate evidence synthesized from the literature on trauma management in LRCS, and expert opinion where this evidence base does not exist. Although JTS CPGs are developed by subject matter experts from high-resource settings, EXTRACCT CPG development features equal or greater representation from trauma care providers in LRCS to ensure applicability and appropriateness to the target context [7, 8]. Over time, continued refinement of the EXTRACCT CPGs based on local casualty data will improve their specificity for LRCS where treatment algorithms may differ from those best-suited to high-resource military trauma systems. Additionally, EXTRACCT CPGs increase their accessibility to a variety of practitioner levels through simple ","journal":"World Journal of Surgery","year":2025,"id":555591,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9573,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1422539,"name":"Aparna Cheran","orcid":null,"position":1,"is_corresponding":false},{"id":1422033,"name":"Amila Ratnayake","orcid":"0000-0002-2678-2667","position":2,"is_corresponding":false},{"id":600022,"name":"Adam L. Kushner","orcid":"0000-0002-7797-4837","position":3,"is_corresponding":false},{"id":1288813,"name":"Hannah Wild","orcid":"0000-0003-0974-0956","position":4,"is_corresponding":false},{"id":1453857,"name":"Nina Weston","orcid":"0009-0001-5194-1850","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-19T02:54:59.329539Z","pmid":"40445110","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}