Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

Abstract

Objective: To present the radiological features of blastrelated injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. INTRODUCTION Mechanisms of injuryThe patterns of blast-related injuries are categorized according to the basic effect of explosion (Table 1). This categorization provides a valuable theoretical framework for understanding blast injuries. However, various mechanisms occur together and victims usually have complicated injuries.1,2 Primary injuries occur secondary to the direct effect of changes in the atmospheric pressure caused by the blast wave, which is an intense over-pressurization impulse created by the explosion. Gas-filled structures such as the middle ear, lung and the gastrointestinal tract are most susceptible. Secondary blast injuries result from flying debris and fragments. They can be seen in any part of the body and are considered to be the most common cause of explosion-related injuries. Fragments would be metallic (shrapnel) or non-metallic. Furthermore, bony fragments from other individuals can be encountered. Tertiary blast injuries occur when the victim body is thrown over by the blast wind producing blunt or penetrating trauma. Quaternary blast injuries are caused by burns, toxic inhalation and exposure to radiation.

Ankara bombing: distribution of injury patterns with radiological imaging

“…Shrapnel was detected in all these patients by X-ray or CT. SBIs were detected in 62/77 (80.5%) of the victims. In the literature review, SBI dominancy was found in open-space bombings [5,6,11,12]. The blast wind also propels people onto hard surfaces, causing blunt or tertiary injuries generally manifested as fractures [6,7,9].…”

“…These seven patients underwent vascular repair surgery, and two were amputated below the knee. In the study by Yazgan and Aksu, of the 28 people brought to the hospital after the explosion in Ankara, the most common injury site was the torso, with the lower extremity injuries being fewer [11]. This may be because the more severe cases, including extremity injury, were admitted to our hospital, which was the nearest centre to the scene.…”

Distribution Characteristics of Combat-related Shrapnel and Relationship with Weapon Type and Conflict Location: Experiences In An Operational Field Hospital

“…They also indicated that evaluation with radiography and contrast-enhanced CT played an integral part in the diagnostic assessment. Yazgan et al [9] studied the radiological features of blast-related injuries observed in the 2015 Ankara bombing victims. They also specified that the most common injury pattern was secondary to blast injury, and that the torso was the most commonly injured body part in unarmored civilians.…”

Emergency department triage in terrorism and warfare disasters

“…Kuarterner blast yaralanmaları ise yanık, crush ve inhalasyon yaralanmaları gibi diğer etkenlerin sonucundaki tüm hasarlardır. Ankara'da 10 Ekim 2015 tarihindeki bomba patlamaları sonucundaki yaralanmalar incelendiğinde en fazla hasarın sekonder blast yaralanmaları ile oluştuğu görülmüştür (6) . Özel-likle gövde, toraks ve abdomen yaralanmaları olan olguların travma skorlarının daha şiddetli yaralanma gösterdiği izlenmiştir.…”

“…ESI'yi diğer triaj sistemlerinden farklı yapan özel-lik, acil müdahale gerektiren hastaların belirlenmesi ve hastanın acil serviste kaç kaynak kullanacağının tahmin edilmesi birlikteliğinin olmasıdır (5,6) . Bu sistemde bir bekleme süresi verilmez, yalnızca öncelik sırası belirtilir.…”