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Civilian casualties of terror-related explosions

The impact of vascular trauma on treatment and prognosis

Heldenberg, Eitan MD; Givon, Adi; Simon, Daniel MD†; Bass, Arie MD; Almogy, Gidon MD; Peleg, Kobi PhD the Israeli Trauma Group

Journal of Trauma and Acute Care Surgery: September 2016 - Volume 81 - Issue 3 - p 435–440
doi: 10.1097/TA.0000000000001123
Original Articles
Editor's Choice

Objectives A high prevalence (10%) of vascular trauma (VT) was previously described in terror-related trauma as compared with non–terror-related trauma (1%), in a civilian setting. No data regarding outcome of VT casualties of improvised explosive device (IED) explosions, in civilian settings, are available. The aim of the current study is to present the prognosis of civilian casualties of IED explosions with and without VT.

Methods A retrospective analysis of the Israeli National Trauma Registry was performed. All patients in the registry from September 2000 to December 2005 who were victims of explosions were included. These patients were subdivided into patients with VT (n = 109) and non-VT (NVT) (n = 1,152). Both groups were analyzed according to mechanism of trauma, type and severity of injury, and treatment.

Results Of 1,261 explosion casualties, there were 109 VT victims (8.6%). Patients with VT tended to be more complex, with a higher injury severity score (ISS): 17.4% with ISS 16 to 24 as compared with only 10.5%. In the group of critically injured patients (ISS, 25–75), 51.4% had VT compared with only 15.5% of the NVT patients. As such, a heavy share of hospitals’ resources were used—trauma bay admission (62.4%), operating rooms (91.7%), and intensive care unit beds (55.1%). The percentage of VT patients who were admitted for more than 15 days was 2.3 times higher than that observed among the NVT patients. Lower-extremity VT injuries were the most prevalent. Although many resources are being invested in treating this group of patients, their mortality rate is approximately five times more than NVT (22.9% vs. 4.9%).

Conclusions Vascular trauma casualties of IED explosions are more complex and have poorer prognosis. Their higher ISS markedly increases the hospital’s resource utilization, and as such, it should be taken into consideration either upon the primary evacuation from the scene or when secondary modulation is needed in order to reduce the burden of the hospitals receiving the casualties.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level V.

From the Department of Vascular surgery (E.H., A.B.), Assaf Harofe Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; National Center for Trauma & Emergency Medicine research (A.G., K.P.), The Gertner Institute for Health Policy & Epidemiology, Israel; Trauma unit, Sheba Medical Center (D.S.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Trauma Unit, Hebrew University (G.A.), Hadassah Medical Center, Jerusalem, Israel; and Department of Disaster Medicine (K.P.), School of Public Health, Tel Aviv University, Israel.

Submitted: March 23, 2015, Revised: March 25, 2016, Accepted: April 4, 2016, Published online: May 27, 2016.

*Israeli Trauma Group: H. Bahouth, A. Becker, A. Hadary, M. Jeroukhimov, I. Karawani, B. Kessel, Y. Klein, G. Lin, O. Merin, B. Miklosh, Y. Mnouskin, A. Rivkind, G. Shaked, G. Sivak, D. Soffer, M. Stein and M. Weiss.


Address for reprints: Eitan Heldenberg, MD, Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; email:

© 2016 Lippincott Williams & Wilkins, Inc.