Abdominal Trauma After Terrorist Bombing Attacks Exhibits a Unique Pattern of Injury
Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Annals of surgery
(Impact Factor: 8.33).
08/2008; 248(2):303-9. DOI: 10.1097/SLA.0b013e318180a3f7
The recent growth in the volume of civilian blast trauma caused by terrorist bombings warrants special attention to the specific pattern of injury associated with such attacks.
To characterize the abdominal injuries inflicted by terrorist-related explosions and to compare the pattern of injury with civilian, penetrating and blunt, abdominal trauma.
Retrospective analysis of prospectively collected data from 181 patients with abdominal trauma requiring laparotomy, who were admitted to the Hadassah Hospital, Jerusalem, Israel, from October 2000 to December 2005. Patients were divided into 3 groups according to mechanism of injury: terror-related blast injury (n = 21), gunshot wounds (GSW) (n = 73) and blunt trauma (n = 87).
Median injury severity score in the blast group was significantly higher compared with GSW and blunt groups (34, 18, and 29, respectively, P < 0.0001). Injury to multiple body regions (> or = 3) occurred in 85.7% of blast group, 28.8% of GSW group, and 59.7% of blunt group (P < 0.001). The pattern of intra-abdominal injury was different between the groups. Bowel injury was found in 71.4% of blast victims, 64.4% of GSW, and 25.3% of blunt group (P < 0.001). Parenchymal injury was found in one third of patients in blast and GSW groups versus 60.9% of patients in blunt group (P = 0.001). Penetrating shrapnel was the cause of bowel injury in all but 1 patient in the blast group (94.4%).
Terrorist attacks generate more severe injuries to more body regions than other types of trauma. Abdominal injury inflicted by terrorist bombings causes a unique pattern of wounds, mainly injury to hollow organs. Shrapnel is the leading cause of abdominal injury following terrorist bombings.
Available from: sciencedirect.com
- "Injuries from IEDs follow an 'all or nothing' pattern; casualties either die from catastrophic polytrauma resulting from direct impact, or sustain relatively minor injuries as a result of the associated indirect energy dissipation. Bala et al. found that median injury severity score in IED casualties is significantly higher compared with gunshot wounds (GSW, 34 and 18, respectively, p <0.0001) and that injury to multiple body regions (3) occurs in 86 and 29% of IED and GSW victims, respectively (p < 0.001). In general, IEDs generate more severe injuries to more body regions than individual firearms. "
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ABSTRACT: Bachground: Reports on genitourinary (GU) trauma during the Iraqi conflict have been limited to battlefield injuries. We sought to characterize the incidence, mechanism of injury, wounding pattern, and management of lower GU injuries sustained in civil violence during the Iraqi war.
Patients and Methods
A total of 2800 casualties with penetrating trauma to the abdomen and pelvis were treated at the Yarmouk Hospital, Baghdad from January 2004 to June 2008. Of the casualties 504 (18%) had GU trauma including 217 (43%) with I or more injuries to the lower GU organs.
Among the 217 patients there were 262 lower GU injuries involving the bladder in 128 (48.8%) patients, bulbo-prostatic urethra in 21 (8%), penis in 24 (9.2%), and scrotum in 89 (34%). Injuries to the anterior urethra and genitals were inflicted by Improvised Explosive Devices (IEDs) in 53% - 67% of cases and by individual firearms in 33% - 47%, while injuries to the posterior urethra and bladder were inflicted by IEDs in 17% - 22% of cases and by firearms in 78% - 83%. All penile wounds were repaired save 3 (12.5%) patients who underwent total penectomy. Of 63 injured testicles 54 (86%) could be salvaged and 9 (14%) required unilateral orchiectomy. The leading cause of death was an associated injury to major blood vessels in 26 (84%) of 31 patients who died.
Injuries to the anterior urethra and genitals were commonly caused by IEDs, while injuries to the posterior urethra and bladder were usually caused by individual firearms. Testis injury was almost always salvageable. Associated trauma to major blood vessels was the leading cause of death in these casualties.
Available from: Miklosh Bala
- "Penetrating injuries caused by flying debris and shrapnel are present in more than 85% of patients [12,17]. We have previously analyzed predictors for severe injuries requiring more urgent care such as severe BLI and intra-abdominal injury [18,19]. Our past experience has shown that among patients admitted to the ED, injury to four or more body regions, and the presence of penetrating head and torso injuries are predictors of BLI and intra-abdominal injury, respectively [16,20]. "
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ABSTRACT: Critical hospital resources, especially the demand for ICU beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA). Our primary objective was to identify easily diagnosed external signs of injury that will serve as indicators of the need for ICU admission. Our secondary objective was to analyze under- and over-triage following suicidal bombing attacks.
A database was collected prospectively from patients who were admitted to Hadassah University Hospital Level I Trauma Centre, Jerusalem, Israel from August 2001-August 2005 following a SBA. One hundred and sixty four victims of 17 suicide bombing attacks were divided into two groups according to ICU and non-ICU admission.
There were 86 patients in the ICU group (52.4%) and 78 patients in the non-ICU group (47.6%). Patients in the ICU group required significantly more operating room time compared with patients in the non-ICU group (59.3% vs. 25.6%, respectively, p=0.0003). For the ICU group, median ICU stay was 4 days (IQR 2 to 8.25 days). On multivariable analysis only the presence of facial fractures (p=0.014), peripheral vascular injury (p=0.015), injury≥4 body areas (p=0.002) and skull fractures (p=0.017) were found to be independent predictors of the need for ICU admission. Sixteen survivors (19.5%) in the ICU group were admitted to the ICU for one day only (ICU-LOS=1) and were defined as over-triaged. Median ISS for this group was significantly lower compared with patients who were admitted to the ICU for >1 day (ICU-LOS>1). This group of over-triaged patients could not be distinguished from the other ICU patients based on external signs of trauma. None of the patients in the non-ICU group were subsequently transferred to the ICU.
Our results show that following SBA, injury to ≥4 areas, and certain types of injuries such as facial and skull fractures, and peripheral vascular injury, can serve as surrogates of severe trauma and the need for ICU admission. Over-triage rates following SBA can be limited by a concerted, focused plan implemented by dedicated personnel and by the liberal utilization of imaging studies.
Available from: Leonard A Levy
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ABSTRACT: This article is part of a collaborative effort by experts in the field of emergency preparedness to com- plete an overview begun by the late Michael Shannon, MD, MPH, on the current challenges and future direc- tions in pediatric disaster readi- ness. This particular article, "Preparation for Terrorist Threats: Explosive Devices," will promote a greater awareness of explosive de- vices as significant terrorism threat and pertinent clinical considera- tions in caring for pediatric victims of explosive injury.
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