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01/02/2017

Trauma: Le terrorisme + grave que la violence

Violence-related Versus Terror-related Stabbings: Significant Differences in Injury Characteristics.

Rozenfeld M et Al. Ann Surg. 2017 Jan 24. doi: 10.1097/SLA.0000000000002143
 
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Les évènements récents ont confronté notre système de santé à de nouveaux enjeux. Ces derniers impose une réflexion sur notre organisation historiquement basée sur la prise en charge de traumatisés de la route. L'experience israélienne est intéressante car elle devrait nous pousser à faire évoluer notre système.
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OBJECTIVE:

To demonstrate the gap between injury epidemiology of terror-related stabbings (TRS) and non-terror-related intentional stabbings.

BACKGROUND:

Terror attacks with sharp instruments have multiplied recently, with many victims of these incidents presented to hospitals with penetrating injuries. Because most practical experience of surgeons with intentional stabbing injuries comes from treating victims of interpersonal violence, potential gaps in knowledge may exist if injuries from TRS significantly differ from interpersonal stabbings (IPS).

METHODS:

A retrospective study of 1615 patients from intentional stabbing events recorded in the Israeli National Trauma Registry during the period of "Knife Intifada" (January 2013-March 2016). All stabbings were divided into TRS and IPS. The 2 categories were compared in terms of sustained injuries, utilization of hospital resources, and clinical outcomes.

RESULTS:

TRS patients were older, comprised more females and were ethnically homogenous. Most IPS incidents happened on weekdays and at night hours, whereas TRS events peaked midweek during morning and afternoon hours. TRS patients had more injuries of head, face, and neck, and severe head and neck injuries. IPS patients had more abdomen injuries; however, respective injuries in the TRS group were more severe. Greater injury severity of the TRS patients reflected on their higher hospital resources utilization and greater in-hospital mortality.

CONCLUSIONS:

Victims of terror stabbings are profoundly different in their characteristics, sustain injuries of a different profile and greater severity, require more hospital resources, and have worse off clinical outcomes, emphasizing the need of the healthcare systems to adjust itself appropriately to deal successfully with future terror attacks.

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