DOI: 10.1097/01.sla.0000256107.84051.23
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PMID: 17435560
Issn Print: 0003-4932
Publication Date: 2007/03/01
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Excerpt
The authors suggest a novel scoring system as a predictor of intra-abdominal injury following a suicide bombing attack. Their idea is original and may contribute to the correct triage and timely treatment of these patients. However, I note two possible problems with this system and with their conclusions.
First, this new “predictor” system takes into consideration the number of injured areas, mainly by penetrating objects. Analyzing their own data, they could not find any patient whose injury was caused by the blast effect, and all of them were injured by penetrating shrapnel. This observation contradicts previous experience by the same institution and others where abdominal blast injuries contributed to a small but important portion of severe injuries. Treating several patients from the last suicide attack in Tel Aviv 1 month ago, we had 2 patients who suffered intra-abdominal blast injuries caused by the blast effect and not by penetrating objects. Thus, relying on the “predictor” system and on the authors' experience may be dangerous and may lead to delay in the diagnosis and timely treatment of these injuries.
Second, I think that the authors misinterpreted the results and conclusions of Einav et al2 published in Annals of Surgery 2 years ago. The results of Einav et al clearly show that, even in large urban areas, less than half of the urgent casualties were evacuated to a trauma center. Thus, they raise once again the concept of the “evacuation hospital” for primary resuscitation and stabilization. In addition Einav et al clearly state that in their opinion these patients should be evacuated to a nearby, well-prepared, and well-equipped hospital. Therefore, the Almogy et al conclusions and recommendations about field triage and evacuation to a level 1 trauma center may be wrong and potentially dangerous.
