title: Abdominal trauma after terrorist bombing attacks exhibits a unique pattern of injury.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To characterize the abdominal injuries inflicted by terrorist-related explosions and to compare the pattern of injury with civilian, penetrating and blunt, abdominal trauma.
  
  
  METHODS
  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).
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
authors.forename: Avraham I
authors.initials: AI
authors.lastname: Rivkind
authors.forename: Gideon
authors.initials: G
authors.lastname: Zamir
authors.forename: Tal
authors.initials: T
authors.lastname: Hadar
authors.forename: Iryna
authors.initials: I
authors.lastname: Gertsenshtein
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
authors.forename: Alon J
authors.initials: AJ
authors.lastname: Pikarsky
authors.forename: Dalit
authors.initials: D
authors.lastname: Amar
authors.forename: Noam
authors.initials: N
authors.lastname: Shussman
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu Gazala
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
mesh_terms: D000007:Abdominal Injuries / Q000145:classification / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005107:Explosions; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D007813:Laparotomy / Q000379:methods; D008297:Male; D008887:Military Medicine / Q000379:methods*; D009104:Multiple Trauma / Q000145:classification / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D023481:Terrorism; D014193:Trauma Centers; D014194:Traumatology / Q000379:methods; D014948:Wounds, Gunshot / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*