Thoracoabdominal injuries after a bomb explosion: blast injuries and their clinical effects.

PURPOSE: To report the types and effects of injuries to the thoracoabdominal region caused by blast and emphasize the importance of the early detection of primary blast injuries.

METHODS: Of the 98 patients injured as a result of a bomb explosion, 31 with thoracoabdominal injuries were included in the study. The demographic and laboratory data, operations performed, and radiological findings were obtained from the electronic records of the patients. The injuries caused by the explosion were divided into four categories as primary, secondary, tertiary, and quaternary. The patients with a new injury severity score (NISS) of ≥ 16 were considered to have critical injuries.

RESULTS: While mortality developed in 16 (51.6%) of 31 patients included in the study, 15 (48.4%) were discharged after treatment. The mean ages of the patients in the mortality and survivor groups were 29.6 ± 4.5 and 31.1 ± 10.7 years, respectively (p > 0.005). When the two groups were examined, the rate of hypovolemic shock and NISS score were significantly higher in the mortality group (p = 0.001 and p < 0.001, respectively) and the pH of the patients in the mortality group was more acidic (7.18 ± 0.13 vs. 7.34 ± 0.13, p = 0.002). One patient in the survivor group required surgery after the explosion due to missed primary blast injuries.

CONCLUSIONS: To make the best use of resources in terrorist attacks and mass casualties that place a huge burden on health systems, it is important to evaluate patients with the highest index of suspicion for concealed blast injuries in terms of hospitalization and observation. In addition, health systems need to develop a cost-effective strategy considering the possibility of delayed-onset blast injuries.