- Injury profile: extremity-predominant, mainly penetrating (43%) and shrapnel (31%), with notable acoustic trauma and a small severe blast and crush subgroup.
- Casualties were young and predominantly male: median age 24 years, 84% male; 26.5% had ISS ≥16 among those recorded.
- Early resource demand high: 23.4% emergency surgery, 10.9% ventilation, 5.2% transfusion; implications for limb-salvage surgery, blood-bank, intensive care and audiological follow-up.
Am J Emerg Med. 2026 Oct 20;111:47-54. doi: 10.1016/j.ajem.2026.10.022. Online ahead of print.
ABSTRACT
INTRODUCTION: Modern asymmetric warfare and large-scale terror attacks produce distinctive wounding patterns that differ from conventional state-on-state conflict and impose specific early demands on receiving trauma systems. The 7 October 2023 attack on southern Israel and the ensuing war generated a compressed surge of combined civilian and military casualties. We characterized injury patterns and linked them to early in-hospital resource use at a single tertiary trauma centre across the opening weeks of the conflict.
METHODS: We performed a retrospective descriptive cohort study of 192 consecutive trauma casualties admitted between 7 October and 24 December 2023. Demographics, mechanism of injury, injured anatomical regions, Injury Severity Score (ISS) and acute interventions were abstracted from the institutional trauma dataset. Mechanism and anatomical categories were not mutually exclusive. Variables were summarised as medians (IQR) or counts (percentages); missing data were not imputed and percentages were computed over non-missing observations.
RESULTS: Casualties were young (median age 24 years, IQR 21-35) and predominantly male (84.4%). Penetrating (43.2%) and shrapnel (31.2%) mechanisms predominated, followed by acoustic trauma (12.0%). Extremities were most often injured (lower limb 41.7%, upper limb 35.4%); 68.8% had at least one extremity injury and 37.0% had two or more injured regions. Median ISS was 9 (IQR 4-16); 26.5% of those with a recorded ISS had ISS ≥16. Blast and crush carried the highest median ISS (25 and 16). Early resource use was substantial: 23.4% required emergency surgery via direct emergency-room-to-operating-room transfer, 10.9% mechanical ventilation and 5.2% packed red-cell transfusion.
CONCLUSIONS: This extremity-predominant, penetrating-and-shrapnel profile, with a small but disproportionately severe blast and crush subgroup and frequent acoustic trauma, translated into early demand for emergency surgery, ventilation and transfusion. These patterns support resourcing limb-salvage and damage-control surgery, blood-bank and intensive-care readiness, and audiologic follow-up in military and mass-casualty trauma planning.
PMID:42945812 | DOI:10.1016/j.ajem.2026.10.022
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
