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Citation
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Gebran A, Khalil EA, Moheb ME, Albaini O, Warea ME, Ibrahim R, Karam K, Helou MOE, Ramly EP, Hechi ME, Matar A, Zeineddine J, Dabar G, Hajj AA, Saad GA, Hoballah J, Safadi B, Kaafarani HMA. Ann. Surg. 2021; ePub(ePub): ePub. |
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Abstract
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This is a multicenter study that reports the demographics, injury characteristics, hospital management, and outcomes of the injured patients in the Beirut blast. We demonstrated that the severity of injury was inversely correlated with the distance from the blast, and mildly injured patients overwhelmed the ED in the early hours.
OBJECTIVE: This multicenter study aims to describe the injury patterns, emergency management and outcomes of the blast victims, recognize the gaps in hospital disaster preparedness, and identify lessons to be learned. SUMMARY BACKGROUND DATA: On August 4th, 2020, the city of Beirut, Lebanon suffered the largest urban explosion since Hiroshima and Nagasaki, resulting in hundreds of deaths and thousands of injuries.
METHODS: All injured patients admitted to four of the largest Beirut hospitals within 72 hours of the blast, including those who died on arrival or in the emergency department (ED), were included. Medical records were systematically reviewed for: 1) patient demographics and comorbidities, 2) injury severity and characteristics, 3) prehospital, ED, operative, and inpatient interventions, and 4) outcomes at hospital discharge. Lessons learned are also shared.
RESULTS: An estimated total of 1,818 patients were included, out of which 30 died on arrival or in the ED and 315 were admitted to the hospital. Among admitted patients, the mean age was 44.7 years (range: 1 week - 93 years), 44.4% were female, and the median injury severity score (ISS) was 10 (5, 17). ISS was inversely related to the distance from the blast epicenter (r = - 0.18, p = 0.035). Most injuries involved the upper extremities (53.7%), face (42.2%), and head (40.3%). Mildly injured (ISS < 9) patients overwhelmed the ED in the first 2 hours; from hour 2 to hour 8 post-injury, the number of moderately, severely, and profoundly injured patients increased by 127%, 25% and 17%, respectively. A total of 475 operative procedures were performed in 239 patients, most commonly soft tissue debridement or repair (119 patients, 49.8%), limb fracture fixation (107, 44.8%), and tendon repair (56, 23.4%). A total of 11 patients (3.5%) died during the hospitalization, 56 (17.8%) developed at least one complication, and 51 (16.2%) were discharged with documented long-term disability. Main lessons learned included: 1) the importance of having key hospital functions (e.g. laboratory, OR) underground, 2) the non-adaptability of electronic medical records to disasters, 3) the ED overwhelming with mild injuries, delay in arrival of the severely injured, and 4) the need for realistic disaster drills.
CONCLUSIONS: We, therefore, describe the injury patterns, emergency flow and trauma outcome of patients injured in the Beirut port explosion. The clinical and system-level lessons learned can help prepare for the next disaster.
Language: en |