Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA .
Ann Surg. 2022 Feb 1;275(2):398-405. doi: 10.1097/SLA.0000000000005322.
This multicenter study aims to describe the injury patterns, emergency management and outcomes of the blast victims, recognize the gaps in hospital disaster preparedness, and identify lessons to be learned.
On August 4th, 2020, the city of Beirut, Lebanon suffered the largest urban explosion since Hiroshima and Nagasaki, resulting in hundreds of deaths and thousands of injuries.
All injured patients admitted to four of the largest Beirut hospitals within 72 hours of the blast, including those who died on arrival or in the emergency department (ED), were included. Medical records were systematically reviewed for: patient demographics and comorbidities; injury severity and characteristics; prehospital, ED, operative, and inpatient interventions; and outcomes at hospital discharge. Lessons learned are also shared.
An estimated total of 1818 patients were included, of which 30 died on arrival or in the ED and 315 were admitted to the hospital. Among admitted patients, the mean age was 44.7 years (range: 1 week-93 years), 44.4% were female, and the median injury severity score (ISS) was 10 (5, 17). ISS was inversely related to the distance from the blast epicenter (r = --0.18, P = 0.035). Most injuries involved the upper extremities (53.7%), face (42.2%), and head (40.3%). Mildly injured (ISS <9) patients overwhelmed the ED in the first 2 hours; from hour 2 to hour 8 post-injury, the number of moderately, severely, and profoundly injured patients increased by 127%, 25% and 17%, respectively. A total of 475 operative procedures were performed in 239 patients, most commonly soft tissue debridement or repair (119 patients, 49.8%), limb fracture fixation (107, 44.8%), and tendon repair (56, 23.4%). A total of 11 patients (3.5%) died during the hospitalization, 56 (17.8%) developed at least 1 complication, and 51 (16.2%) were discharged with documented long-term disability. Main lessons learned included: the importance of having key hospital functions (eg, laboratory, operating room) underground; the nonadaptability of electronic medical records to disasters; the ED overwhelming with mild injuries, delay in arrival of the severely injured; and the need for realistic disaster drills.
We, therefore, describe the injury patterns, emergency flow and trauma outcome of patients injured in the Beirut port explosion. The clinical and system-level lessons learned can help prepare for the next disaster.
这项多中心研究旨在描述爆炸受害者的损伤模式、急诊管理和结局，认识到医院灾害准备方面的差距，并总结经验教训。
2020 年 8 月 4 日，黎巴嫩贝鲁特市遭遇了自广岛和长崎以来最大的城市爆炸，造成数百人死亡，数千人受伤。
在爆炸发生后 72 小时内，将所有被送入贝鲁特 4 家最大医院的受伤患者，包括在到达或急诊部死亡的患者，都纳入研究。对病历进行系统回顾，记录：患者人口统计学和合并症；损伤严重程度和特征；院前、急诊、手术和住院干预；以及出院时的结局。还分享了总结的经验教训。
估计共有 1818 名患者被纳入研究，其中 30 名患者在到达或急诊部死亡，315 名患者住院。在住院患者中，平均年龄为 44.7 岁（范围：1 周-93 岁），44.4%为女性，损伤严重程度评分（ISS）中位数为 10（5，17）。ISS 与距爆炸震中距离呈负相关（r=-0.18，P=0.035）。大多数损伤涉及上肢（53.7%）、面部（42.2%）和头部（40.3%）。ISS＜9 的轻度损伤患者在伤后 2 小时内使急诊室不堪重负；从伤后 2 小时到 8 小时，中度、重度和极重度损伤患者的数量分别增加了 127%、25%和 17%。239 名患者共进行了 475 次手术，最常见的是软组织清创或修复（119 名患者，49.8%）、四肢骨折固定（107 名患者，44.8%）和肌腱修复（56 名患者，23.4%）。共有 11 名（3.5%）患者在住院期间死亡，56 名（17.8%）患者至少发生 1 种并发症，51 名（16.2%）患者出院时有记录的长期残疾。主要经验教训包括：重要的是让关键医院功能（如实验室、手术室）处于地下位置；电子病历不适应灾害；急诊室因轻度损伤患者过多而不堪重负，重伤患者到达延迟；以及需要进行现实的灾难演习。
因此，我们描述了在贝鲁特港口爆炸中受伤患者的损伤模式、急诊流程和创伤结局。临床和系统层面的经验教训可以帮助为下一次灾难做好准备。
