title: Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015.
abstract: OBJECTIVE
  The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 deaths and 352 wounded. Facing these multisite terrorist attacks, Parisian public and military hospitals simultaneously managed numerous patients with penetrating thoracic injuries. The aim of this study was to analyse this cohort, the injury patterns, and assess the results of this mobilization.
  
  
  METHODS
  The clinical records of all patients admitted to Parisian public and military hospitals with a penetrating thoracic injury related to the Paris 13 November terrorist attacks were reviewed.
  
  
  RESULTS
  The study group included 25 patients (7% of the casualties) with a mean age of 34 ± 8 years and a majority of gunshot wounds ( n =  20, 80%). Most patients presented with severe thoracic injury (Abbreviated Injury Score Thorax 3.3 ± 1.2), and also associated non-thoracic injuries in 21 cases (84%). The mean Injury Severity Score was 26.8 ± 9.4. Eight patients (32%) were managed with chest tube insertion and 17 (68%) required thoracic surgery. Lung resection, diaphragmatic repair, and lung suture were performed in 6 (36%), 6 (35%), and 5 cases (29%), respectively. Extra-thoracic surgical procedures were performed in 16 patients, mostly for injuries to the extremities. Postoperative mortality was 12% ( n =  3) and postoperative morbidity was 60% ( n =  15).
  
  
  CONCLUSIONS
  The coordination of Parisian military and civilian hospitals allowed the surgical management of 25 patients. The mortality is high but consistent with what has been reported in previous series. The current times expose us to the threat of new terrorist attacks and require that the medical community be prepared.
authors.affiliation: Division of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Boddaert
authors.affiliation: Division of Thoracic and Vascular Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.affiliation: Division of Thoracic Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery. Sorbonne Paris Cité, Paris 13 University, Faculty of Medicine SMBH, Bobigny, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Martinod
authors.affiliation: Division of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Aguir
authors.affiliation: Division of Cardiac surgery, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris Curie University, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Department of Anaesthesiology and Intensive Care, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris Curie University, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.affiliation: Division of Cardiac Surgery, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est University, Créteil, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Couëtil
authors.affiliation: Division of Cardiac Surgery, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est University, Créteil, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiore
authors.affiliation: Department of Anaesthesiology and Intensive Care, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Universités, UPMC Univ Paris 06, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lescot
authors.affiliation: Division of Visceral and General Surgery, Bégin Military Teaching Hospital, Saint-Mandé, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Malgras
authors.affiliation: French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Pons
authors.affiliation: Division of Thoracic and Vascular Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010297:Paris / Q000453:epidemiology; D012189:Retrospective Studies; D023481:Terrorism; D013898:Thoracic Injuries / Q000453:epidemiology* / Q000601:surgery*; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000601:surgery*; D055815:Young Adult
keywords: Gunshot wound; Penetrating thoracic injury; Suicide-bombing attack; Terrorist attack