Rutland-Brown Wesley, Langlois Jean A, Nicaj Leze, Thomas Robert G, Wilt Susan A, Bazarian Jeffrey J
Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Division of Injury Response, Atlanta, Georgia 30341-3724, USA.
Prehosp Disaster Med. 2007 May-Jun;22(3):157-64. doi: 10.1017/s1049023x00004593.
The 11 September 2001 terrorist attacks on the World Trade Center (WTC) resulted in thousands of deaths and injuries. Research on previous bombings and explosions has shown that head injuries, including traumatic brain injuries (TBIs), are among the most common injuries.
The objective of this study was to identify diagnosed and undiagnosed (undetected) TBIs among persons hospitalized in New York City following the 11 September 2001 WTC attacks.
The medical records of persons admitted to 36 hospitals in New York City with injuries or illnesses related to the WTC attacks were abstracted for signs and symptoms of TBIs. Diagnosed TBIs were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Undiagnosed TBIs were identified by an adjudication team of TBI experts that reviewed the abstracted medical record information. Persons with an undiagnosed TBI were contacted and informed of the diagnosis of potential undetected injury.
A total of 282 records were abstracted. Fourteen cases of diagnosed TBIs and 21 cases of undiagnosed TBIs were identified for a total of 35 TBI cases (12% of all of the abstracted records). The leading cause of TBI was being hit by falling debris (22 cases). One-third of the TBIs (13 cases) occurred among rescue workers. More than three years after the event, four out of six persons (66.67%) with an undiagnosed TBI who were contacted reported they currently were experiencing symptoms consistent with a TBI.
Not all of the TBIs among hospitalized survivors of the WTC attacks were diagnosed at the time of acute injury care. Some persons with undiagnosed TBIs reported problems that may have resulted from these TBIs three years after the event. For hospitalized survivors of mass-casualty incidents, additional in-hospital, clinical surveys could help improve pre-discharge TBI diagnosis and provide the opportunity to link patients to appropriate outpatient services. The use and adequacy of head protection for rescue workers deserves re-evaluation.
2001年9月11日对世界贸易中心（WTC）的恐怖袭击导致数千人伤亡。对以往爆炸事件的研究表明，头部受伤，包括创伤性脑损伤（TBI），是最常见的损伤类型之一。
本研究的目的是确定2001年9月11日世贸中心袭击事件后在纽约市住院的人员中已诊断和未诊断（未被发现）的创伤性脑损伤情况。
对纽约市36家收治与世贸中心袭击事件相关伤病人员的医院的病历进行摘要，以查找创伤性脑损伤的体征和症状。使用《国际疾病分类》第9版临床修订本诊断代码确定已诊断的创伤性脑损伤。未诊断的创伤性脑损伤由一个创伤性脑损伤专家评审小组确定，该小组审查了摘要的病历信息。与未诊断出创伤性脑损伤的人员进行联系，并告知其可能存在未被发现损伤的诊断结果。
共摘要了282份病历。确定了14例已诊断的创伤性脑损伤病例和21例未诊断的创伤性脑损伤病例，共计35例创伤性脑损伤病例（占所有摘要病历的12%）。创伤性脑损伤的主要原因是被坠落碎片击中（22例）。三分之一的创伤性脑损伤病例（13例）发生在救援人员中。事件发生三年多后，在被联系的6例未诊断出创伤性脑损伤的人员中，有4例（66.67%）报告他们目前正经历与创伤性脑损伤相符的症状。
世贸中心袭击事件住院幸存者中的创伤性脑损伤并非在急性损伤救治时都得到了诊断。一些未诊断出创伤性脑损伤的人员在事件发生三年后报告了可能由这些创伤性脑损伤导致的问题。对于大规模伤亡事件的住院幸存者，额外的院内临床调查有助于改善出院前创伤性脑损伤的诊断，并为将患者与适当的门诊服务联系起来提供机会。救援人员头部防护装备的使用情况及其充足性值得重新评估。
