Limor Aharonson-Daniel, PhD¹, Yoram Kluger, MD, FACS², Adi Giveon, BA¹, and Kobi Peleg, PhD MPH¹. (1) Israel Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Services Research, Sheba Medical Center, Tel Hashomer, 52621, Israel, 972-3-5354252, limorad@gertner.health.gov.il, (2) Department of Surgery, Tel-Aviv Medical Center, Rabin Trauma Center, 6 Weitzman St., Tel Aviv, Israel

Background: Estimating the risk to life of injured patients is a key factor in setting priority for treatment and in quality control of treatment provided. The Injury Severity Score (ISS) is probably the most widely applied instrument for assessing severity. ISS was designed to account for the additional risk associated with multiple injuries by summing severity scores for up to three (most severely) body regions injured. Bomb-explosion victims suffer a higher proportion of severe injuries compared to other forms of trauma. Yet even within the severity groups, bomb-explosion victims suffered more severe consequences. This presentation aims to demonstrate why this occurs and to explicate the need for a measure that will reflect more accurately the severity of complex injuries.

Methods: Retrospective analysis of National-Trauma-Registry Data. Bomb-explosion casualties were compared with other traumatic injuries in regard to their injury characteristics, the number of body-regions involved in each injury and the number of diagnoses within a body region.

Findings: 55646 casualties were included of which 870 (1.6%) were victims of bomb-explosion. 10.7% of bomb-explosion injuries involved four or more body-regions compared to 1.5% in other trauma. Among patients with an isolated head injury, bomb-explosion patients had 29% with three or more diagnoses compared with 8% in other trauma. Conclusions: ISS does not adequately reflect the severity of bomb-explosion patients because it only accounts for one most severe injury per region with a maximum of 3 regions whereas bomb-explosion patients often have 4 or more body-regions injured with multiple injuries within each region.

Learning Objectives:

• By the end of the session the audience will gain awareness to the fact that bomb explosion victims are more severely injured than other patients, even within an identical severity indicator. The audience will also understand why ISS does not reflect the true severity in terror victims.

Keywords: Injuries, Indicators

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.