Peleg Kobi, Aharonson-Daniel Limor, Stein Michael, Michaelson Moshe, Kluger Yoram, Simon Daniel, Noji Eric K
Center for Trauma & Emergency Medicine Research, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel.
Ann Surg. 2004 Mar;239(3):311-8. doi: 10.1097/01.sla.0000114012.84732.be.
An increase of terror-related activities may necessitate treatment of mass casualty incidents, requiring a broadening of existing skills and knowledge of various injury mechanisms.
To characterize and compare injuries from gunshot and explosion caused by terrorist acts.
A retrospective cohort study of patients recorded in the Israeli National Trauma Registry (ITR), all due to terror-related injuries, between October 1, 2000, to June 30, 2002. The ITR records all casualty admissions to hospitals, in-hospital deaths, and transfers at 9 of the 23 trauma centers in Israel. All 6 level I trauma centers and 3 of the largest regional trauma centers in the country are included. The registry includes the majority of severe terror-related injuries. Injury diagnoses, severity scores, hospital resource utilization parameters, length of stay (LOS), survival, and disposition.
A total of 1155 terror-related injuries: 54% by explosion, 36% gunshot wounds (GSW), and 10% by other means. This paper focused on the 2 larger patient subsets: 1033 patients injured by terror-related explosion or GSW. Seventy-one percent of the patients were male, 84% in the GSW group and 63% in the explosion group. More than half (53%) of the patients were 15 to 29 years old, 59% in the GSW group and 48% in the explosion group. GSW patients suffered higher proportions of open wounds (63% versus 53%) and fractures (42% versus 31%). Multiple body-regions injured in a single patient occurred in 62% of explosion victims versus 47% in GSW patients. GSW patients had double the proportion of moderate injuries than explosion victims. Explosion victims have a larger proportion of minor injuries on one hand and critical to fatal injuries on the other. LOS was longer than 2 weeks for 20% (22% in explosion, 18% in GSW). Fifty-one percent of the patients underwent a surgical procedure, 58% in the GSW group and 46% in explosion group. Inpatient death rate was 6.3% (65 patients), 7.8% in the GSW group compared with 5.3% in the explosion group. A larger proportion of gunshot victims died during the first day (97% versus 58%).
GSW and injuries from explosions differ in the body region of injury, distribution of severity, LOS, intensive care unit (ICU) stay, and time of inpatient death. These findings have implications for treatment and for preparedness of hospital resources to treat patients after a terrorist attack in any region of the world. Tailored protocol for patient evaluation and initial treatment should differ between GSW and explosion victims. Hospital organization toward treating and admitting these patients should take into account the different arrival and injury patterns.
与恐怖主义相关活动的增加可能需要对大规模伤亡事件进行救治，这就要求拓宽对各种损伤机制的现有技能和知识。
描述和比较恐怖袭击导致的枪伤和爆炸伤。
对2000年10月1日至2002年6月30日期间录入以色列国家创伤登记处（ITR）的患者进行回顾性队列研究，所有患者均因与恐怖主义相关的损伤。ITR记录了以色列23个创伤中心中9个中心的所有伤亡患者入院情况、院内死亡情况及转院情况。纳入了该国所有6个一级创伤中心和3个最大的区域创伤中心。该登记处涵盖了大多数与恐怖主义相关的严重损伤。记录损伤诊断、严重程度评分、医院资源利用参数、住院时间（LOS）、生存率和处置情况。
共有1155例与恐怖主义相关的损伤：54%由爆炸导致，36%为枪伤（GSW），10%由其他方式导致。本文重点关注两个较大的患者亚组：1033例因与恐怖主义相关的爆炸或枪伤而受伤的患者。71%的患者为男性，枪伤组为84%，爆炸组为63%。超过一半（53%）的患者年龄在15至29岁之间，枪伤组为59%，爆炸组为48%。枪伤患者开放性伤口（63%对53%）和骨折（42%对31%）的比例更高。62%的爆炸受害者出现单个患者多个身体部位受伤，而枪伤患者为47%。枪伤患者中度损伤的比例是爆炸受害者的两倍。爆炸受害者一方面轻伤比例较大，另一方面重伤至致命伤的比例较大。20%的患者住院时间超过2周（爆炸组为22%，枪伤组为18%）。51%的患者接受了外科手术，枪伤组为58%，爆炸组为46%。住院死亡率为6.3%（65例患者），枪伤组为7.8%，而爆炸组为5.3%。更大比例的枪伤受害者在第一天死亡（97%对58%）。
枪伤和爆炸伤在受伤身体部位、严重程度分布、住院时间、重症监护病房（ICU）住院时间和住院死亡时间方面存在差异。这些发现对治疗以及全球任何地区遭受恐怖袭击后医院治疗患者的资源准备工作都有影响。针对枪伤和爆炸伤受害者的患者评估和初始治疗的定制方案应有所不同。医院在治疗和收治这些患者方面的组织工作应考虑到不同的到达和损伤模式。
