title: Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion.
abstract: OBJECTIVE
  Though tympanic membrane perforation (TMP) is a marker of barotrauma, relation to severity of injury has been contested based on previous observations that following an explosion many victims with significant injuries do not suffer from TMP while many victims with TMP do not suffer from significant injuries. The objective of this study was to reassess the relationship of TMP to severity of injury and resource demand in patients treated in multiple casualty incidents following terrorist bombings treated in one medical center.
  
  
  METHODS
  Retrospective review.
  
  
  RESULTS
  Most of the patients with TMP were mildly injured. Nevertheless, TMP was more prevalent in patients with moderate and severe injuries, 53.3 % compared to 13.6 % in mildly injured patients (p = 0.0009). Patients with TMP suffered from more body areas injured (p < 0.0001). They more often needed surgery (30.6 vs. 5.5 %; p < 0.0001), ICU hospitalization (16.1 vs. 1.3 %; p < 0.0001) and secondary transfer to a level I trauma center (12.9 vs. 1.0 %; p < 0.0001). They were hospitalized longer (p < 0.0001). Fifty-three (12.6 %) patients included in this study were not examined by the ENT service. Most of those not examined were either moderately or severely injured.
  
  
  CONCLUSIONS
  Patients with TMP were more severely injured and more often needed surgery, ICU hospitalization and need for transfer to a level I trauma center. The observation that all those who died in hospital and most of those who were unstable were not examined by the ENT services suggests that impact of TMP as an indicator of severity may be underestimated.
authors.affiliation: Department of Surgery, Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel. i_ashkenazi@yahoo.com.
authors.forename: I
authors.identifier: http://orcid.org/0000-0002-6305-4159
authors.initials: I
authors.lastname: Ashkenazi
authors.affiliation: Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Olsha
authors.affiliation: Emergency Surgery Department, Gregorio Marañon Medical Center, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Turegano-Fuéntes
authors.affiliation: Department of Surgery, Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Alfici
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001753:Blast Injuries / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005107:Explosions; D005260:Female; D006295:Health Resources; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007557:Israel; D008297:Male; D054527:Mass Casualty Incidents / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers; D018058:Tympanic Membrane Perforation / Q000401:mortality* / Q000473:pathology; D055815:Young Adult
keywords: Blast injuries; Multiple casualty incidents; Tympanic membrane perforation; Wounds and injuries