贝鲁特硝酸铵爆炸：一项评估损伤特征和结局的多中心研究。
The Beirut ammonium nitrate blast: A multicenter study to assess injury characteristics and outcomes.
机构信息
From the Faculty of Health Sciences (S. Al-Hajj, S.H.F.) and Department of Pathology and Laboratory Medicine (S.H.F.), American University of Beirut; Department of Emergency Medicine (H.Z., M.A.H., A.J.M.), American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine (M.A.T.), Emory University, Atlanta, Georgia; Department of Neurosurgery (A.H.), American University of Beirut Medical Center; Faculty of Medicine (S.W., S.K., Y.F., F.F.), American University of Beirut; Department of Psychiatry (L.T.), American University of Beirut Medical Center; American University of Beirut (S. Arjinian); Emergency Medicine Department (E.A.Z., M.E.H.), Lebanese American University Medical Center; Faculty of Medicine (N.S.), Saint Joseph University, Beirut, Lebanon; and Department of Emergency Medicine (H.M.), Yale Medicine School, New Haven, Connecticut.
出版信息
J Trauma Acute Care Surg. 2023 Feb 1;94(2):328-335. doi: 10.1097/TA.0000000000003745. Epub 2022 Aug 24.
BACKGROUND
Blasts incidents impose catastrophic aftermaths on populations regarding casualties, sustained injuries, and devastated infrastructure. Lebanon witnessed one of the largest nonnuclear chemical explosions in modern history-the August 2020 Beirut Port blast. This study assesses the mechanisms and characteristics of blast morbidity and mortality and examines severe injury predictors through the Injury Severity Score.
METHODS
A retrospective, multicenter cross-sectional study was conducted. Data of trauma patients presenting to five major acute-care hospitals in metropolitan Beirut up to 4 days following the blast were collected in a two-stage process from patient hospital chart review and follow-up phone calls.
RESULTS
A total of 791 patients with a mean age of 42 years were included. The mean distance from the blast was 2.4 km (SD, 1.9 km); 3.1% of victims were in the Beirut Port itself. The predominant mechanism of injury was being struck by an object (falling/projectile) (293 [37.0%]), and the most frequent site of injury was the head/face (209 [26.4%]). Injury severity was low for 548 patients (71.2%), moderate for 62 (8.1%), and severe/critical for 27 (3.5%). Twenty-one deaths (2.7%) were recorded. Significant serious injury predictors (Injury Severity Score, >15) were sustaining multiple injuries (odds ratio [OR], 2.62; p = 0.005); a fracture (OR, 5.78; p < 0.001); primary blast injuries, specifically a blast lung (OR, 18.82; p = 0.001), concussion (OR, 7.17; p < 0.001), and eye injury (OR, 8.51; p < 0.001); and secondary blast injuries, particularly penetrating injuries (OR, 9.93; p < 0.001) and traumatic amputations (OR, 13.49; p = 0.01). Twenty-five percent were admitted to the hospital, with 4.6% requiring the intensive care unit. At discharge, 25 patients (3.4%) had recorded neurologic disability.
CONCLUSION
Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast overpressure and projectile fragments. Understanding blast injuries characteristics, their severity, and management is vital to informing emergency services, disaster management strategies, hospital preparedness, and, consequently, improving patient outcomes.
LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.
背景
爆炸事件对人口造成了灾难性的后果，包括伤亡、持续受伤和基础设施破坏。黎巴嫩发生了现代历史上最大的非核化学爆炸之一——2020 年 8 月贝鲁特港爆炸事件。本研究评估了爆炸发病率和死亡率的机制和特征，并通过损伤严重程度评分检查了严重损伤的预测因素。
方法
这是一项回顾性、多中心的病例对照研究。在爆炸发生后 4 天内，从贝鲁特大都市的五家主要急性护理医院的患者病历回顾和后续电话随访中，收集了 791 名创伤患者的数据。
结果
共纳入 791 名平均年龄为 42 岁的患者。平均距离爆炸地点 2.4 公里（标准差，1.9 公里）；3.1%的受害者在贝鲁特港本身。受伤的主要机制是被物体击中（坠落/抛射物）（293 [37.0%]），受伤最常见的部位是头部/面部（209 [26.4%]）。548 名患者（71.2%）的损伤严重程度较低，62 名（8.1%）为中度，27 名（3.5%）为严重/危急。记录到 21 例死亡（2.7%）。显著严重损伤的预测因素（损伤严重程度评分，>15）为多发性损伤（优势比[OR]，2.62；p=0.005）；骨折（OR，5.78；p<0.001）；原发性爆炸伤，特别是爆炸肺（OR，18.82；p=0.001）、脑震荡（OR，7.17；p<0.001）和眼部损伤（OR，8.51；p<0.001）；和继发性爆炸伤，特别是穿透性损伤（OR，9.93；p<0.001）和创伤性截肢（OR，13.49；p=0.01）。25%的患者住院治疗，其中 4.6%需要重症监护病房。出院时，25 名患者（3.4%）记录有神经功能障碍。
结论
爆炸受害者的大多数伤害是轻微的。严重的伤害主要与爆炸超压和弹片有关。了解爆炸伤的特征、严重程度和处理方法对于指导急救服务、灾害管理策略、医院准备工作至关重要，从而改善患者预后。
证据水平
预后和流行病学；三级。
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