Suicide bombing attacks: Can external signs predict internal injuries?
OBJECTIVE
To report the distribution and types of injuries in victims of suicide bombing attacks and to identify external signs that would guide triage and initial management.


BACKGROUND
There is a need for information on the degree to which external injuries indicate internal injuries requiring emergency triage.


METHODS
The medical charts and the trauma registry database of all patients who were admitted to the Hadassah Hospital in Jerusalem from August 2001 to August 2004 following a suicide bombing attack were reviewed and analyzed for injury characteristics, number of body areas injured, presence of blast lung injury (BLI), and need for therapeutic laparotomy. Logistic analysis was performed to identify predictors of BLI and intra-abdominal injury.


RESULTS
The study population consisted of 154 patients who were injured as a result of 17 attacks. Twenty-eight patients suffered from BLI (18.2%) and 13 patients (8.4%) underwent therapeutic laparotomy. Patients with penetrating head injury and those with > or =4 body areas injured were significantly more likely to suffer from BLI (odds ratio, 3.47 and 4.12, respectively, P < 0.05). Patients with penetrating torso injury and those with > or =4 body areas injured were significantly more likely to suffer from intra-abdominal injury (odds ratio, 22.27 and 4.89, respectively, P < 0.05).


CONCLUSIONS
Easily recognizable external signs of trauma can be used to predict the occurrence of BLI and intra-abdominal injury. The importance of these signs needs to be incorporated into triage protocols and used to direct victims to the appropriate level of care both from the scene and in the hospital.
Almogy
Gidon
G
Department of Surgery and Trauma Unit, Hadassah Medical Center, Jerusalem, Israel. galmogy@Hadassah.org.il
Mintz
Yoav
Y
Zamir
Gideon
G
Bdolah-Abram
Tali
T
Elazary
Ram
R
Dotan
Livnat
L
Faruga
Mohammed
M
Rivkind
Avraham I
AI
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000150:complications* / Q000453:epidemiology; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000453:epidemiology; D005107:Explosions; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis*; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D023481:Terrorism; D014218:Triage / Q000458:organization & administration*