Indicators of the need for ICU admission following suicide bombing attacks

Miklosh Bala,Tali Bdolah-Abram,Gidon Almogy,Dafna Willner,Asaf Keidar,Avraham I Rivkind

doi:10.1186/1757-7241-20-19

Abstract

IntroductionCritical hospital resources, especially the demand for ICU beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA). Our primary objective was to identify easily diagnosed external signs of injury that will serve as indicators of the need for ICU admission. Our secondary objective was to analyze under- and over-triage following suicidal bombing attacks.MethodsA database was collected prospectively from patients who were admitted to Hadassah University Hospital Level I Trauma Centre, Jerusalem, Israel from August 2001-August 2005 following a SBA. One hundred and sixty four victims of 17 suicide bombing attacks were divided into two groups according to ICU and non-ICU admission.ResultsThere were 86 patients in the ICU group (52.4%) and 78 patients in the non-ICU group (47.6%). Patients in the ICU group required significantly more operating room time compared with patients in the non-ICU group (59.3% vs. 25.6%, respectively, p = 0.0003). For the ICU group, median ICU stay was 4 days (IQR 2 to 8.25 days). On multivariable analysis only the presence of facial fractures (p = 0.014), peripheral vascular injury (p = 0.015), injury ≥ 4 body areas (p = 0.002) and skull fractures (p = 0.017) were found to be independent predictors of the need for ICU admission. Sixteen survivors (19.5%) in the ICU group were admitted to the ICU for one day only (ICU-LOS = 1) and were defined as over-triaged. Median ISS for this group was significantly lower compared with patients who were admitted to the ICU for > 1 day (ICU-LOS > 1). This group of over-triaged patients could not be distinguished from the other ICU patients based on external signs of trauma. None of the patients in the non-ICU group were subsequently transferred to the ICU.ConclusionsOur results show that following SBA, injury to ≥ 4 areas, and certain types of injuries such as facial and skull fractures, and peripheral vascular injury, can serve as surrogates of severe trauma and the need for ICU admission. Over-triage rates following SBA can be limited by a concerted, focused plan implemented by dedicated personnel and by the liberal utilization of imaging studies.

Highlights

Critical hospital resources, especially the demand for intensive care unit (ICU) beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA)
We retrospectively reviewed the records of all victims of suicide bombing attacks who were admitted to Hadassah University Hospital EinKerem Campus (HUH), in Jerusalem between August 2001 and August 2005
Patient population From August 2001 to August 2005 there were 17 suicide bombing attacks in Jerusalem. 430 patients were examined in the Emergency Department of HUH and 167 patients (38.8%) were admitted

Summary

Introduction

Especially the demand for ICU beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA). To optimize the treatment of mass casualties and the chaos that ensues, victims need to be directed to the appropriate level of care, and life-threatening injuries need to be swiftly recognized and treated. In these circumstances early diagnosis depends on a well-functioning trauma system, adequate logistics, sufficient training, a focused physical examination and use of targeted imaging studies. Several studies have shown that critical hospital resources, the demand for intensive care unit (ICU) beds, are usually severely stressed following a SBA [5,6].

Objectives

Methods

Results

Conclusion