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332 Beirut port blast: a multi-center study to assess injury characteristics and outcomes
  1. Samar Al-Hajj1,
  2. Sarah H Farran1,2,
  3. Hady Zgheib3,
  4. Mohamad Ali Tfaily4,
  5. Adham Halaoui5,
  6. Sarah Wehbe6,
  7. Stephanie Karam6,
  8. Yaser Fadlallah6,
  9. Fares Fahd6,
  10. Lana Toufaili7,
  11. Sebouh Arjinian8,
  12. Elie Al-Zaghrini9,
  13. Moustafa Al Hariri3,
  14. Mahmoud El Hussein9,
  15. Naji Souaiby10,
  16. Hani Mowafi11,
  17. Afif Jean Mufarrij3
  1. 1Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  2. 2Department of Pathology and Laboratory Medicine, American University of Beirut, Lebanon
  3. 3Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  4. 4Department of Internal Medicine, Emory University, Atlanta, USA
  5. 5Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
  6. 6Faculty of Medicine, American University of Beirut, Beirut, Lebanon
  7. 7Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
  8. 8American University of Beirut, Beirut, Lebanon
  9. 9Emergency Medicine Department, Lebanese American University Medical Center, Beirut, Lebanon
  10. 10Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  11. 11Department of Emergency Medicine, Yale Medicine School, New Haven, USA


Importance Understanding injuries and their outcomes in the Beirut Blast is vital to informing mass-casualty and disaster management strategies and improving injury outcomes for victims.

Background Blasts incidents impose catastrophic aftermaths on populations in terms of casualties, sustained injuries and devastated infrastructure. Lebanon witnessed one of the largest non-nuclear chemical explosions in modern history – the August 2020 Beirut Port Blast. This study assesses the mechanisms and characteristics of blast morbidity and mortality and examines the predictors of severe injury as measured by the Injury Severity Score (ISS).

Design A retrospective, multi-center cross-sectional study. Data were collected in a two-stage process involving patient hospital chart review and follow-up phone calls.

Setting Five major acute-care hospitals in metropolitan Beirut.

Participants Trauma patients presenting to participating hospitals up to 4 days following the blast.

Main Outcomes Injury severity and mortality following blast injury.

Results 791 patients were included with a median age of 42 years. The mean distance from the blast was 2.4 km (SD 1.9 km), 3.1% of victims were in the Beirut Port itself. The predominant mechanism of injury was being struck by an object (falling or projectile) (293, 37.0%) and the most frequent site of injury was the head or face (209, 26.4%). Injury severity was low for 548 (71.2%) patients, moderate for 62 (8.1%), and severe or critical for 27 (3.5%). Twenty-one deaths were recorded (2.7%). Significant predictors of serious injury (ISS>15) were sustaining multiple injuries (OR=2.62, p=0.005) including a fracture (OR= 5.78, p<0.001), primary injuries, specifically a blast lung (OR= 18.82, p=0.001), concussion (OR=7.17, p<0.001), and eye injury (OR=8.51, p<0.001). Secondary injuries overall, particularly penetrating injuries (OR=9.93, p<0.001) and traumatic amputations (OR=13.49, p=0.01). 25.0% were admitted to the hospital, with 4.6% requiring the ICU. At discharge, 25 patients (3.4%) had recorded neurologic disability.

Conclusions and Relevance Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast pressure and projectile fragments. Understanding the characteristics of blast injuries, their severity and their management are vital to informing emergency services, disaster management strategies and hospital preparedness and consequently improving patient outcomes.

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