The Beirut ammonium nitrate blast: A multicenter study to assess injury characteristics and outcomes

Abstract

BACKGROUND:Blasts incidents impose catastrophic aftermaths on populations regarding casualties, sustained injuries, and devastated infrastructure. Lebanon witnessed one of the largest nonnuclear 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 severe injury predictors through the Injury Severity Score. METHODS:A retrospective, multicenter cross-sectional study was conducted. Data of trauma patients presenting to five major acute-care hospitals in metropolitan Beirut up to 4 days following the blast were collected in a two-stage process from patient hospital chart review and follow-up phone calls. RESULTS:A total of 791 patients with a mean age of 42 years were included. 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/projectile) (293 [37.0%]), and the most frequent site of injury was the head/face (209 [26.4%]). Injury severity was low for 548 patients (71.2%), moderate for 62 (8.1%), and severe/critical for 27 (3.5%). Twenty-one deaths (2.7%) were recorded. Significant serious injury predictors (Injury Severity Score, >15) were sustaining multiple injuries (odds ratio [OR], 2.62; p = 0.005); a fracture (OR, 5.78; p < 0.001); primary blast 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); and secondary blast injuries, particularly penetrating injuries (OR, 9.93; p < 0.001) and traumatic amputations (OR, 13.49; p = 0.01). Twenty-five percent were admitted to the hospital, with 4.6% requiring the intensive care unit. At discharge, 25 patients (3.4%) had recorded neurologic disability. CONCLUSION:Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast overpressure and projectile fragments. Understanding blast injuries characteristics, their severity, and management is vital to informing emergency services, disaster management strategies, hospital preparedness, and, consequently, improving patient outcomes.

Esophageal pressure monitoring and its clinical significance in severe blast lung injury

“…Post-injury vital signs indicated an increased HR, a decreased MAP, and an increased SI, aligning with the changes observed in central hemodynamic parameters (CI and SVI), volumetric parameters (GEDI and ITBI), and vascular peripheral resistance (SVRI). These findings are consistent with the lung ultrasonography scores and anatomical observations, corroborating previous clinical retrospective studies and laboratory research on blast injuries ( Zhang et al, 2015 ; Yuanbo et al, 2016 ; Tong et al, 2018 ; Smith and Garner, 2019 ; April et al, 2021 ; Carius et al, 2022 ; Al-Hajj et al, 2023 ). Previous studies have demonstrated that prompt and effective arterial blood gas analysis following BLI is crucial for diagnosing conditions and developing treatment plans ( Manera et al, 2020 ; Xue et al, 2020 ; Chong et al, 2021 ; Shi et al, 2022 ).…”

“…Currently, both nationally and internationally, there is a paucity of research on the changes in respiratory mechanics following severe BLI. Most animal-based studies have focused on the mechanisms of injury, post-injury pathophysiological alterations, and their underlying molecular mechanisms ( Scott et al, 2017 ; Nguyen et al, 2019 ; Smith and Garner, 2019 ; Hazell et al, 2022 ; Shakargy et al, 2022 ; Al-Hajj et al, 2023 ). There has been insufficient exploration into the maintenance programs for post-injury respiratory function, especially those concerning variations in respiratory mechanics parameters monitored by Pes in animals afflicted with severe BLI; such studies are notably absent in the existing literature.…”

Estimating Blast Exposures From The 2020 Beirut Explosion And Examining Correlation With Blast Injuries

“…The high incidence of laceration injuries aligns with previous studies on the Beirut injuries [7], [10], which can be attributed to people being close to their windows to watch or film the initial fire before the blast [17]. Very few participants reported having 'internal injuries' (N=11) with a total of four reporting tympanic membrane (eardrum) rupture.…”

“…Previous investigations into the injury patterns resulting from the Beirut blast have consistently noted a substantial prevalence of secondary blast injuries, primarily attributed to extensive failure of glazing [7]- [10]. However, these earlier studies lack accurate documentation of victims' locations at the time of the explosion.…”

Repetitive, but Not Single, Mild Blast TBI Causes Persistent Neurological Impairments and Selective Cortical Neuronal Loss in Rats

“…The 2020 Beirut port explosion, which was the largest non-nuclear explosion in recent history, was caused by the detonation of 2750 tons of inappropriately stored ammonium nitrate fertilizer; this explosion, occurring in an urban environment, resulted in over 6000 civilian injuries and 200 fatalities [ 10 ]. A multicentre study of the injury characteristics of patients presenting at emergency departments after the Beirut explosion found that 6.2% had concussion originating from primary blast exposure [ 11 ]. The current (2022) conflict in Ukraine has seen cities and civilian infrastructure targeted by artillery and guided weapons [ 12 ].…”