Are injuries from terror and war similar? A comparison study of civilians and soldiers.

OBJECTIVE To compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers. SUMMARY BACKGROUND DATA Injuries from terror and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that are often far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking. METHODS A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000-12/2006). RESULTS Terror and war accounted for trauma hospitalizations among 1784 civilians and 802 soldiers. Most civilians (93%) were injured in terror and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely in terror than war. Soldiers tended to present with less severe injuries from war than from terror. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terror who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terror (7%) than war (2%) casualties, and particularly among civilians. CONCLUSIONS This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terror and war. Hospital preparedness and management should focus on treating combat injuries that result from specific causes-terror or war.