Biomedical subjects

Kobi Peleg

Publications and source records attributed to Kobi Peleg.

At least 19 recordsLinked to original sources

PubMed2006

Childhood burns in Israel: a 7-year epidemiological review.

INTRODUCTION: Understanding the etiology of severe burns injuries and identifying high risk groups are essential for allotting resources for prevention and treatment. The objective of this study was to develop a profile of severe childhood burns in Israel. METHODS: A retrospective study of children (ages 0-14) hospitalized with a burn, between 1998 and 2004. Data from all five burn units in Israel was retrieved from the National Trauma Registry. RESULTS: Two thousand seven hundred and five children were hospitalized with burns (51% of all burn admissions). Infants (ages 0-1) had the highest prevalence (45%). Scalds caused 68% of burns. Burn extent in 83% of the patients was less than 20% TBSA, 3% suffered 40%TBSA burns. Surgical intervention increased from 6% in 1998 to 21% in 2002. Non-Jewish children sustained proportionally more burn injuries (48%). Among Jewish children an increase in burn injuries was noted on Thursdays and Fridays. CONCLUSION: Infants, boys and non-Jewish children were found to be at greatest risk for a burn injury, while older children were at higher risk for severe burns. Prevention programs should target these high risk groups, with an emphasis on the unique characteristics of each group. Policy makers should reassess the benefits of a pediatric burn unit in Israel. The increase in rates of surgical intervention should be further investigated.

Burns↗

PubMed2006

Does body armor protect from firearm injuries?

BACKGROUND: Bullet-proof vests and helmets protect from harm in combat and military engagements. The use of armor against shrapnel has been studied, yet little has been documented as to how they protect from high velocity gunshots. This study aims to describe the medical consequences of high velocity firearm injuries and to differentiate between patients injured while using protective wear and those injured unprotected. STUDY DESIGN: National trauma registry data on injury characteristics, treatment and outcomes between October 1, 2000 and December 31, 2003 were retrieved and analyzed. RESULTS: There were 669 terror-related firearm injuries recorded: 236 (37.8%) in soldiers (protected) and 433 (62.2%) in civilians (unprotected). Injury severity was notably higher in civilian patients (31% versus 16% with Injury Severity Score>or=16). Civilians had more ICU care (26% versus 20%, p=0.06), and double the inpatient mortality (8.6% [n=37] versus 3.4% [n=8] patients). Protected body regions such as abdomen, chest, and brain, were injured less frequently. Once a traumatic brain injury was sustained, no statistical differences were found in severity distribution, ICU stay, or inpatient death between protected and unprotected patients. But injury severity in patients with chest injuries was much higher in those who were unprotected (Injury Severity Score>or=25, 41% versus 23%, respectively, p=0.08). This increased severity could be attributed partly to more multiple injuries involving the chest. Abdominal injuries showed a similar pattern. CONCLUSIONS: Body armor has a protective effect on victims of high velocity gunshot wounds; lower rates of head, brain, chest, and abdominal injuries are seen. In addition, armor reduces the severity of injuries to the chest and the abdomen.

Chi-Square Distribution↗

PubMed2006

In-hospital resource utilization during multiple casualty incidents.

OBJECTIVE: To suggest guidelines for hospital organization during terror-related multiple casualty incidents (MCIs) based on the experience of 6 level I trauma centers. SUMMARY BACKGROUND DATA: Most terror-related MCIs are bombings. The sporadic nature of these events complicates in-hospital preparation. METHODS: Data were collected at all level I Trauma centers during/after MCIs for the Israel National Trauma registry. Patients were included if they were admitted or died in hospital following injury in suicide bombings (October 1, 2000 to June 30, 2003), which fulfilled Ministry of Health suggested criteria for MCIs (number of admissions, severity of injury). RESULTS: Included were 325 casualties from 32 events, 34% of which had an Injury Severity Score >16. A third of the admissions arrived within 10 minutes and 65% within 30 minutes. Forty percent of the patients underwent CT scans directly from the ED. Operative procedures were performed on 60% of patients and 36% were transferred directly from the ED to the OR. Initiation of surgical procedures peaked at 1 to 1.5 hours, mainly multidisciplinary abdominal, thoracic, and vascular surgery. Orthopedic and plastic surgery predominated later. A third of the patients were admitted to ICUs, often (31%) directly from the ED. CONCLUSIONS: High staffing demands for ED, OR, and ICU overlap. Anesthesiologists, general, thoracic, and vascular surgeons are in immediate demand. ICU admissions occur simultaneously with ongoing patient arrival to the ED. Most patients operated within the first 2 hours require multidisciplinary surgical teams. Demand for orthopedic and plastic surgery and anesthesiology services continues for >24 hours.

Adolescent↗

PubMed2006

Suicide bombers form a new injury profile.

BACKGROUND: Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect. METHODS: Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed. RESULTS: A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. CONCLUSIONS: Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity.

Adolescent↗

PubMed2006

Terror-inflicted thermal injury: A retrospective analysis of burns in the Israeli-Palestinian conflict between the years 1997 and 2003.

BACKGROUND: Terror attacks have changed in the past decade, with a growing tendency toward explosives and suicide bombings, which led to a rise in the incidence of thermal injuries among victims. The Israeli-Palestinian conflict of October 2000 marked a turning point when an organized terror campaign commenced. This article presents data of terror-associated burns from the Israeli National Trauma Registry (ITR) during the years 1997 to September 2000 and October 2000 to 2003. METHODS: We analyzed demographic and clinical characteristics of 219 terror-related burn patients and 6,546 other burn patients admitted to hospitals in Israel between 1997 and 2003. Data were obtained from the ITR. RESULTS: Burns contributed about 9% of all terror related trauma and about 5% of all other trauma (p < 0.0001). These percentages have not changed significantly before and after October 2000. Terror-related burns afflict Jewish males more than predicted by their percentage in the population, whereas other burns afflict non-Jewish males more than predicted. Adults and young adults (15-59 years) are the predominant group in terror-related burns (80%), whereas children younger than 15 years are the predominant group in other burns (50%). Large burns (20% to 89% total body surface area) are more common in terror casualties, with greater mortality (6.4% in terror-related versus 3.4% in others; p = 0.0258). CONCLUSION: Although the incidence of burns has risen because of an organized campaign, this change was noticeable in other trauma forms as well in similar proportions. Terror-related burns afflict a targeted population, and generally take on a more severe course with greater mortality rates, thus requiring appropriate medical treatment.

Adolescent↗

PubMed2006

Different AIS triplets: Different mortality predictions in identical ISS and NISS.

BACKGROUND: Previous studies demonstrated different mortality predictions for identical Injury Severity Scores (ISS) from different Abbreviated Injury Scale (AIS) triplets. This study elaborates in both scope and volume producing results of a larger magnitude, applicable to specific injury subgroups of blunt or penetrating, traumatic brain injury, various age groups, and replicated on NISS. METHODS: All patients hospitalized after trauma at 10 hospitals, with ISS/NISS (new ISS) generated by two AIS triplets, excluding patients with isolated minor or moderate injuries to a single body region were studied. Patients were separated into two groups based on the different triplets. Inpatient-mortality rates were calculated for each triplet group. Odds ratios were calculated to estimate the risk of dying in one triplet group as compared with the other. The chi test determined whether the difference in mortality rate between the two groups was significantly different. Differences were further explored for various subgroups. RESULTS: There were 35,827 patients who had ISS/NISS scores generated by two different AIS triplets. Significant differences in death rates were noted between triplet groups forming identical ISS/NISS. Odds ratio for being in the second group (always containing the higher AIS score) ranged from 2.3 to 7.4. CONCLUSIONS: ISS and NISS that are formed by different AIS triplets have significantly different inpatient-mortality rates. The triplet with the higher AIS score has higher inpatient-mortality rates, overall and in several sub-populations of varying vulnerability. The comparison of populations and the interpretation of ISS/NISS based outcome data should take this important information into account and the components of AIS triplets creating each ISS and NISS should be reported.

Abbreviated Injury Scale↗

PubMed2006

Alcohol use among trauma victims admitted to a level I trauma center in Israel.

BACKGROUND: The contribution of drugs and alcohol to current trauma-related morbidity and mortality in Israel is not known. Identification of these factors in the fast-changing demographics of the Israeli population might lead to better care and, no less importantly, to targeted prevention measures. OBJECTIVES: To determine the incidence of alcohol-related trauma, and to specify the time of day, the cause of trauma, and the morbidity and mortality rates as compared to non-alcohol-associated trauma in the tertiary trauma unit of a large medical center in Tel Aviv. METHODS: Data were obtained from the Israel National Trauma Registry, based on patient records in our institution (Tel Aviv Sourasky Medical Center) from January 2001 to December 2003. RESULTS: Of the 5529 patients in the study, 170 had high alcohol blood levels (> 50 mg/dl). Patients intoxicated with alcohol had higher rates of road accident injuries (35% versus 24% non-intoxicated) and stab wounds (29% vs. 7%). The Injury Severity Score of the alcohol-intoxicated patients was higher (32% > or = 16 vs. 12% > 16). The alcohol-intoxicated patients were more likely to be non-Jewish (34% vs. 9%), young (82% aged 15-44 years) and males (91%). Most of the alcohol-related injuries occurred during the weekend (47%) and during evening-late night hours (from 11 p.m. to 7 a.m., 55%). CONCLUSIONS: Alcohol-associated trauma differs from non-alcohol-associated trauma in many ways. Since the population at risk can be identified, it is important that legislative, social, enforcement and educational measures be adopted to reduce the extent of alcohol abuse and thereby improve the level of public safety.

Accidents, Traffic↗

PubMed2006

Secondary transfer of trauma patients: rationale and characteristics.

BACKGROUND: Trauma systems were created in order to provide optimal care for trauma patients. Hence, patients transferred to level I trauma centers are assumed to be transferred due to medical reasons as a result of complex injuries. OBJECTIVES: To explore the reasons for transfer of patients from regional to level I trauma centers in Israel as a basis for establishing a national policy regarding transfers. METHODS: The data on patients transferred to five level I trauma centers during a 6 month period were collected using a structured form. RESULTS: The study population comprised 929 patients transferred from regional hospitals. Most transfers were due to the need for a specialty unavailable at the first hospital (65%) or for special diagnostic equipment (3% in Jews, 23% in Arabs). Only 3.6% of the transferred patients were transferred because of multi-system injury. Some casualties were transferred following their own request, 26% Jews and 3% Arabs. CONCLUSIONS: Most patient transfers concur with the recommendations of the Ministry of Health, namely, the absence of a certain specialty or equipment. The fact that many of the transfers reflect a lack of available resources at the first evacuation destination suggests that increasing the availability of these resources can help reduce secondary triage. It is recommended that a cost-benefit analysis be conducted.

Adolescent↗

PubMed2006

Non-hip fracture-associated trauma in the elderly population.

BACKGROUND: The rate of trauma in the elderly is growing. OBJECTIVES: To evaluate the characteristics of non-hip fracture-associated trauma in elderly patients at a level I trauma center. METHODS: The study database of this retrospective cohort study was the trauma registry of a level I trauma center. Trauma patients admitted from January 2001 to December 2003 were stratified into different age groups. Patients with the diagnosis of hip fracture were excluded. RESULTS: The study group comprised 7629 patients. The non-hip fracture elderly group consisted of 1067 patients, 63.3% women and 36.7% men. The predominant mechanism of injury was falls (70.5%) and most of the injuries were blunt (94.1%). Injury Severity Score was found to increase significantly with age. The average mortality rate among the elderly was 6.1%. Age, ISS, Glasgow Coma Score on admission, and systolic blood pressure on admission were found to be independent predictors of mortality. CONCLUSIONS: Falls remain the predominant cause of injury in the elderly. Since risk factors for mortality can be identified, an effective community prevention program can help combat the future expected increase in morbidity and mortality associated with trauma in the elderly.

Accidental Falls↗

PubMed2005

Blast injuries.

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Blast Injuries↗

PubMed2005

Burn prevention programs for children: do they reduce burn-related hospitalizations?

BACKGROUND: Severe burns in children can result in prolonged suffering, disability, disfigurement, and in impaired physical and mental development. Hospitalization rates of children with burns are much higher than for children with other trauma. Therefore, various child burn prevention programs have been implemented, but their efficacy has been evaluated only by assessment of knowledge or satisfaction rather than evaluating actual changes in burn-related hospitalizations. Our objective was to map Israeli child burn prevention programs and to measure their success from the rate of burn-related hospitalizations. METHODS: A questionnaire-based survey was conducted of organizations participating in injury prevention programs. Official data was obtained on burn-related hospitalizations of children aged 0-4 and 5-14 for 1998 and 2000, and was correlated with the existence or absence of injury prevention programs, and with the population's socio-economic status (SES). RESULTS: In localities with burn prevention programs, there was a reduction in the rate of burn-related hospitalizations of infants, from 1.39 to 1.05 per 1000 infants (p<0.05), in contrast to localities where programs did not exist. The greatest change was in middle and high socio-economic communities. The prevention programs had no similar effects on school-aged children. CONCLUSION: Injury prevention programs are effective in reducing burn-related hospitalizations among infants and toddlers, especially from more affluent communities, but not among school-aged children.

Adolescent↗

PubMed2005

The severity of injury in children resulting from acts against civilian populations.

OBJECTIVE: To characterize the injuries to children by acts against civilian populations (AACP). SUMMARY BACKGROUND DATA: Only 2 articles have focused on the spectrum and severity of injuries to children by AACP. METHODS: A retrospective case study of children 0 to 18 years old who were entered into the Israel National Trauma Registry as a result of AACP between September 29, 2000, and June 30, 2002. RESULTS: A total of 158 children were hospitalized for injuries caused by AACP, accounting for 1.4% of all hospitalized injured children but for 10.9% of all in-hospital deaths for trauma. Explosions injured 114 (72.2%); shootings, 34 (21.5%); and other mechanisms such as stoning or stabbing, 10 (6.3%). Older children were injured by explosions more frequently than younger children (86.1% of 15- to 18-year-olds, 73.7% of 10- to 14-year-olds, 63.2% of 0- to 9-year-olds, P = 0.02). A higher percentage of children injured by explosions rather than by shootings were severely or critically injured (33.9% versus 18.8%, P = 0.10). The most frequently injured body regions were extremities (62.8%), head/face (47.3%), chest and abdomen (37.2%), and brain (18.2%). More than 1 body region was injured in 63.0%. Children injured by explosions as compared with shootings had a lower incidence of abdominal trauma (14.9% versus 20.6%), a similar incidence of chest trauma (16.7% versus 14.7%), but a higher incidence of extremity trauma (65.8% versus 53.0%). There were 7 in-hospital deaths, 6 due to severe head injury and 1 due to severe abdominal trauma; 6 of the 7 deaths were caused by explosions, and all but 1 occurred in children 15 to 18 years old. CONCLUSIONS: AACP cause significant morbidity and mortality in children, especially adolescents. Injury severity is significantly higher among children who are injured by explosions rather than by shootings.

Adolescent↗

PubMed2005

Investigation of Federal Bureau of Investigation bomb-related death and injury data in the United States between 1988 and 1997.

OBJECTIVE: The study of physical injury from terrorist explosives is an increasing international area of research. However, there are few data sets to characterize the scope of injury and death from these devices. Therefore, one option is to begin evaluating statistics reported by a nontraditional public health data source, the U.S. Federal Bureau of Investigation (FBI) Bomb Data Center. METHODS: We reviewed data reported by the FBI Bomb Data Center for the years 1988-1997 and analyzed the number of bomb-related deaths and injuries and incidence of bombings. RESULTS: The FBI reported 17,579 bombings, 427 related deaths, and 4,063 injuries in the United States between 1988 and 1997. The benefits of this data are reporting of information not normally found in public health data, including type of explosive device and explosive composition. The primary limitations include lack of case comparison and unknown methods of data reporting and data collection. CONCLUSION: To completely study physical injury from explosive devices requires a systematic and comprehensive data set. The FBI data provides an interesting statistical resource to assess the scope of injury from bombs in the United States, but at the current time cannot be used for extensive epidemiological analysis.

Blast Injuries↗

PubMed2005

Ending in a crash.

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Accidents, Traffic↗

PubMed2005

Risk for motorcyclists in a busy metropolitan city: the example of Tel Aviv.

BACKGROUND: The proportion of motorcyclists injured in road accidents in Israel is larger than their proportion among road users. OBJECTIVES: To identify factors contributing to the risk of injury motorcyclists as compared to drivers of other motor vehicles. METHODS: We retrieved and analyzed National Trauma Registry data on drivers, aged 16 and above, who were involved in traffic accidents and hospitalized between 1 January 1997 and 30 June 2003. RESULTS: The study group comprised 10,967 patients: 3,055 (28%) were motorcyclists and 7,912 (72%) were drivers of other motor vehicles. A multiple logistic regression revealed that Tel Aviv, the busiest metropolitan city in Israel, is a risk for motorcycle injury as compared to other regions; males have an increased risk compared to females; and age is a protecting factor since the risk of injury as a motorcyclist decreases as age increases. Nevertheless, the population of injured motorcyclists in Tel Aviv was significantly older (mean age 32.5 years vs. 28.6 elsewhere; t-test P < 0.0001). Twenty percent (n = 156) of the injured motorcyclists in Tel Aviv were injured while working, compared to 9.5% (n = 217) in other regions (chi-square P < 0.0001). Motorcycle injuries in Tel Aviv were of lower severity (7.7% vs. 16.4% according to the Injury Severity Scale 16+, chi2 P < 0.0001), and had lower inpatient death rates (1.2% vs. 2.5%, chi2 P = 0.001). CONCLUSIONS: Tel Aviv is a risk for motorcycle injury compared to other regions, males have an increased risk compared to females, and age is a protecting factor. The proportion of motorcyclists in Tel Aviv injured while working is double that in other regions.

Accidents, Traffic↗

PubMed2004

Increased survival among severe trauma patients: the impact of a national trauma system.

HYPOTHESIS: The survival of severe trauma patients is affected by the implementation of a national trauma system, which brought about developments both at the hospital and prehospital levels during the past decade. DESIGN: A retrospective cohort study of all severely injured patients (Injury Severity Score >16) recorded in the Israeli National Trauma Registry at all level I trauma centers in Israel from January 1, 1997, to December 31, 2001. Inpatient death rates were examined overall and by subgroups. SETTING: The National Trauma Registry includes trauma (International Statistical Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 800-959) hospitalizations, patients who were transferred to or from other hospitals, and those who died in the emergency department. It excludes patients who were dead on arrival, discharged following treatment in the emergency department, and patients who do not fall into the definition of trauma. Main Outcome Measure Inpatient death. RESULTS: Seven thousand four hundred twenty-three severe trauma patients were recorded. Inpatient death rates decreased significantly from 21.6% in 1997 to 14.7% in 2001. The odds ratios of mortality in 1998 through 2001 vs 1997, adjusted for year, age, sex, penetrating injury, and severity of injury (Injury Severity Score >25), were 0.92, 0.89, 0.70, and 0.65, respectively, confirming the downward trend. CONCLUSIONS: A steady significant reduction in the inpatient death rate of severe trauma patients hospitalized at all level I trauma centers in Israel between 1997 and 2001 was observed. Although a single factor that explains the reduction was not identified, it is evident that the establishment of the trauma system brought about a significant decrease in mortality. We believe that integrated cooperation of various components of the national trauma system in Israel across the years may explain the reduction.

Adolescent↗

PubMed2004

A geographic information system simulation model of EMS: reducing ambulance response time.

Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. All calls that were pinpointed geographically by the GIS were included, and their data were stratified by weekday and by daily shifts. Geographic areas (polygons) of, at most, 8 minutes response time were simulated for each of these subgroups to maximize the timely response of calls. Before using the GIS model, mean response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes, respectively, with 34% and 62% of calls responded within 8 minutes. When ambulances were positioned within the modeled polygons, more than 94% of calls met the 8-minute criterion. The GIS simulation model presented in this study suggests that EMS could be more effective if a dynamic load-responsive ambulance deployment is adopted, potentially resulting in increased survival and cost-effectiveness.

Ambulances↗

PubMed2004

The special injury pattern in terrorist bombings.

BACKGROUND: The destructive human consequences of terrorist bombing always challenge the medical system in diagnosis, decision making, and patient management. This injury is produced by multiple injury mechanisms, and departs from the conventional description of trauma complexity. Our objective was to characterize and compare terror-bombing victims with casualties of all other kinds of trauma, and to validate the existence of a different, more complex, injury pattern. STUDY DESIGN: A retrospective cohort study was conducted of patient records from October 2000 through June 2003 in the Israeli National Trauma Registry. All were categorized as victims of terrorist bombings or of nonterror-related trauma. Analysis included age, gender, Injury Severity Score, Glasgow Coma Scale, admission blood pressure, injury complexity, surgical interventions, intensive care and hospital lengths of stay, in-hospital mortality, and disposition. This analysis was extended to Injury Severity Score subgroups. RESULTS: Victims of terrorist bombings (n = 906) were compared with 55,033 casualties of nonterror-related trauma. Bombing resulted in significantly different injury complexity, increased severity, and with more body regions involved. Significantly enhanced use of intensive care, prolonged hospital stay, more surgical interventions, and increased hospital mortality are characteristic of these patients. CONCLUSIONS: Terrorist bombings inflict injury of a distinctly different pattern than other means of trauma. The simultaneous combination of different injury mechanisms in explosions results in a multidimensional injury pattern and a complicated clinical course. Hospital preparedness and medical team awareness to the unique nature of the injuries are mandatory for improving the outcomes of these patients.

Adolescent↗