Suicide bombing attacks: Can external signs predict internal injuries?: Almogy G, Mintz Y, Zamir G, et al. Ann Surg 2006;243:541–6

Abstract

This retrospective chart review of victims of suicide bombers in Jerusalem describes the frequency and pattern of injuries as predictors of blast lung injury (BLI) and intra-abdominal injury. The database was prospectively collected and included demographic data, Injury Severity Scores (ISSs), as well as other information related to the event. Over a 2-year period, 17 bombing attacks resulted in 430 patient visits to the Emergency Department. Of these, 157 (37%) patients were admitted and included in this review. External injuries were mapped onto nine different body areas with a multiply injured person defined as having four or more areas affected. Blast environments were recorded into three different settings: buses, semi-confined places, and open spaces. Of the 154 patients, 28 (18%) suffered BLI and the median ISS for these patients was 21. Injuries occurring in buses or semi-confined space were associated with more severe BLI. Independent predictors of BLI were injury to four or more areas (odds ratio [OR] = 4.1; 95% confidence interval [CI] 1.5–11.0) and penetrating head injury (OR = 3.5; 95% CI 1.0–12.1). Predictors of intra-abdominal injury were injury to four or more areas (OR = 4.9; 95% CI 1.8–13.1) and penetrating torso injury (OR = 22.3; 95% CI 2.6–192.6). The authors concluded that the environment of the blast influences BLI and that intra-abdominal injuries are more commonly from direct penetrating injury as opposed to the concussive wave of the blast. Predictably, ISS and multiple injuries also help predict those patients most urgently needing care in the chaotic aftermath of suicide bombings.