title: When a vehicle becomes a weapon: intentional vehicular assaults in Israel.
abstract: BACKGROUND
  We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. We hypothesized that IVA are associated with a specific injury pattern and severity.
  
  
  METHODS
  Retrospective analysis of prospectively acquired data of patients injured following IVA from October 2008 to May 2016 who were admitted to the Hadassah Level I trauma center in Jerusalem, Israel. Comparison of injury parameters and outcome caused by vehicular attacks to non-intentional pedestrian trauma (PT). Measured outcomes included ISS, AIS, injury pattern, ICU and blood requirements, participating teams, length of stay, and mortality.
  
  
  RESULTS
  There were 26 patients in the IVA group. Mean age in the IVA group was significantly younger and there were more males compared to the PT group (24.7 ± 13.3 years vs. 48.3 ± 21.3, and 81% vs. 52%, respectively, p < 0.01). Lower extremity (77% of patients), followed by head (58%) and facial (54%) injuries were most commonly injured in the IVA group, and this was significantly different from the pattern of injury in the PT group (54, 35, and 28%, respectively, p < 0.05). Mean ISS and median head AIS were significantly higher in the IVA group compared with the PT group (23.2 ± 12.8 vs. 15.4 ± 13.8, p = 0.012, and 4.5 vs. 3, p = 0.003, respectively). ICU admission and blood requirement were significantly higher in the IVA group (69% vs. 38%, and 50% vs. 19%, p < 0.01). Mortality was significantly higher in the IVA group (4 patients, 15%, vs. 3 patients, 4%, respectively, p = 0.036) and was caused by severe head trauma in all cases.
  
  
  CONCLUSIONS
  The severity of injury and mortality rate following IVA are higher compared with pedestrian injury. The pattern of injury following IVA is significantly different from non-intentional pedestrian trauma.
  
  
  CONCLUSIONS
  IVA results in higher mortality than conventional pedestrian trauma secondary to more severe head injury. More hospital resources are required following IVA than following conventional road traffic accidents.
authors.affiliation: Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. almogyg@yahoo.com.
authors.forename: Gidon
authors.identifier: http://orcid.org/0000-0002-5709-0057
authors.initials: G
authors.lastname: Almogy
authors.affiliation: Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Asaf
authors.initials: A
authors.lastname: Kedar
authors.affiliation: Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Head trauma; Intentional vehicular trauma; Multiple casualty incidents; Pedestrian trauma; Terrorism