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Mortality in terrorist attacks: a unique modal of temporal death distribution.
Shapira, S C; Adatto-Levi, R; Avitzour, M; Rivkind, A I; Gertsenshtein, I; Mintz, Y.
Afiliación
  • Shapira SC; Administration and Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
World J Surg ; 30(11): 2071-7; discussion 2078-9, 2006 Nov.
Article en En | MEDLINE | ID: mdl-16957818
BACKGROUND: Terror-related multiple casualty incidents (MCI) in Israel since September 2000 have resulted in a new pattern of injury as a result of the mechanisms of trauma. The objective of this study was to asses the temporal death distribution among the civilian casualties in the Jerusalem vicinity during a 3-year period. METHODS: All terrorist attacks in the Jerusalem district from September 2000 to September 2003 were included in this study. The data of all deaths were processed including the time of the attack, the evacuation time to the hospitals, and the time of death. RESULTS: During the study period 28 terror-related MCI occurred. A total of 2328 victims were injured and 273 died, for an overall fatality rate of 11.7%. A unique temporal death distribution was identified; 82.8% of the deaths occurred immediately, at the scene of the attack (scene death); of the remaining 17.2% of patients who died in the hospital, half died within 4 hours of arrival (immediate death), one quarter within 5-24 hours (early death), and one quarter later than that (late death). The temporal death distribution was significantly different when classifying the mechanism of trauma to suicide bombings versus shooting. The scene mortality was higher in the suicide bombings than in shooting attacks (86.7% versus 77%, P = 0.039 ). In contrast, the mortality within 1-24 hours was higher in the shooting attacks (17% versus 6.3%, P = 0.05). CONCLUSIONS: Terror-related MCI occurring in civilian settings have a unique temporal death distribution. A very high scene mortality is seen compared to the classical description of Donald Trunkey1 in 1983. The late deaths, which composed 30% of the mortality in civilian settings, comprise only 4.4% of the total mortality in MCIs. A rough estimate of the in-hospital mortality could be achieved after the first 4 hours, allowing the assessment and distribution of hospital resources. Futile care should be identified early and availability of ICU beds can be calculated according to the immediate mortality.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad / Terrorismo Tipo de estudio: Prognostic_studies Límite: Humans País/Región como asunto: Asia Idioma: En Revista: World J Surg Año: 2006 Tipo del documento: Article País de afiliación: Israel Pais de publicación: Estados Unidos
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad / Terrorismo Tipo de estudio: Prognostic_studies Límite: Humans País/Región como asunto: Asia Idioma: En Revista: World J Surg Año: 2006 Tipo del documento: Article País de afiliación: Israel Pais de publicación: Estados Unidos