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
Source: PubMed


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.

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    • "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[17]. 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)[18]. In general, IEDs generate more severe injuries to more body regions than individual firearms. "
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    • "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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