Civilian casualties of terror-related explosions: The impact of vascular trauma on treatment and prognosis.

Objectives: A high prevalence (10%) of vascular trauma (VT) was previously described in terror- related trauma as compared to 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, is currently 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 09/2000 to 12/2005 who were victims of explosions were included. These patients were subdivided into patients with VT (n=109) and NVT (n=1152). Both groups were analyzed according to mechanism of trauma, type and severity of injury and treatment. Results: Out of 1261 explosion casualties, there were 109 VT victims (8.6%). VT Patients tended to be more complex, with a higher injury severity score (ISS): 17.4% with ISS 16-24 as compared to only 10.5%. In the group of critically injured patients (ISS 25-75) 51.4% were VT compared to 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%), ICU beds (55.1%). The percentage of VT patients that 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 about 5 times more than NVT (22.9% vs. 4.9%). Conclusions: VT 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. (C) 2016 Lippincott Williams & Wilkins, Inc.

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