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Background: In the complex landscape of modern warfare, understanding combat-related injuries leading to hospitalization is crucial for optimizing injury treatment. This study aims to compare combat casualty characteristics and outcomes during the major conflicts between Israel and Hamas in 2023 and 2014 as a basis for understanding the effectiveness of trauma care practices for wounded soldiers. Methods: A cohort study of soldiers hospitalized due to combat injuries during two major wars between Israel and Hamas in 2023 and 2014, using data from the Israeli National Trauma Registry. This study did not include deaths before hospital arrival or casualties who were discharged from the Emergency Department. Results: Of the 1,198 study subjects, 67.8% belonged to the 2023 cohort and 32.2% to the 2014 cohort. The percentage of casualties with severe and critical injuries (Injury Severity Score [ISS] 16–75) was higher among the 2023 cohort (18.6% vs. 13.7%, p = 0.036), as was the percentage of casualties with multiple severe injuries (≥ 2 regions with Abbreviated Injury Score ≥ 3: 11.5% vs. 7.5%, p = 0.035) and firearm injuries (19.6% vs. 14.5%, p = 0.081). Injuries to the torso and extremities were more frequent among the 2023 cohort. Among the critically injured casualties (ISS 25–75), the mortality rates were 17.3% vs. 28.6%, respectively, for the 2023 and 2014 cohorts (p = 0.351); adjusted HR (95% CI): 0.56 (0.21–1.49). The 2023 cohort had higher rates for treatment in the trauma bay (61.5% vs. 47.9%, p < 0.001), ICU utilization (admission: 16.3% vs 11.7%, p = 0.036), surgical intervention (51.5% vs. 42.7%, p = 0.005), longer duration from arrival to surgery (median [interquartile range]: 4.6 (1.2–18.5) vs. 2.6 (1.1–10.1) hours, p = 0.037), and longer hospital stays (> 14 days: 15.5% vs. 8.8%, p < 0.001). Conclusions: Our data demonstrated that more casualties who survived to hospital arrival were severely and multiply injured in the 2023 Israel-Hamas war as compared to the 2014 war. Despite the increased severity, in-hospital survival did not worsen though there was an increase in hospital resource utilization. [ABSTRACT FROM AUTHOR]

Background: During the past two decades, there have been many changes in automotive and medical technologies, road infrastructure, trauma systems, and demographic changes which may have influenced injury outcomes. The aim of this study was to examine injury trends among traffic casualties, specifically private car occupants, hospitalized in Level I Trauma Centers (TC). Methods: A retrospective cohort study was performed based on data from the Israel National Trauma Registry. The data included occupants of private cars hospitalized in all six Level I TC due to a traffic collision related injury between January 1, 1998 and December 31, 2019. Demographic, injury and hospitalization characteristics and in-hospital mortality were analyzed. Chi-squared (X2) test, multivariable logistic regression models and Spearman's rank correlation were used to analyze injury data and trends. Results: During the study period, 21,173 private car occupants (14,078 drivers, 4,527 front passengers, and 2,568 rear passengers) were hospitalized due to a traffic crash. The percentage of females hospitalized due to a car crash increased from 37.7% in 1998 to 53.7% in 2019. Over a twofold increase in hospitalizations among older adult drivers (ages 65+) was observed, from 6.5% in 1998 to 15.7% in 2018 and 12.6% in 2019. While no increase was observed for severe traumatic brain injury, a statistically significant increase in severe abdominal and thoracic injuries was observed among the non-Jewish population along with a constant decrease in in-hospital mortality. Conclusions: This study provides interesting findings regarding injury and demographic trends among car occupants during the past two decades. Mortality among private car occupant casualties decreased during the study period, however an increase in serious abdominal and thoracic injuries was identified. The results should be used to design and implement policies and interventions for reducing injury and disability among car occupants. [ABSTRACT FROM AUTHOR]

Purpose: To compare mortality among severe and critically injured patients who were directly admitted (DA) to level I trauma center (TCI) or level II trauma center (TCII) with those who were transferred to a TCI after being initially admitted to a TCII. Methods: A cohort study of severe and critically injured patients (Injury Severity Score 16–75) hospitalized between 2010 and 2019 using data from the National Program for Trauma Registration. Multivariate logistic regression models estimated mortality risk, including stratified analyses. Results: Of the 27,131 hospitalizations, 9.5% were transfers, 60.1% were DA to TCI and 30.4% were DA to TCII. Children ages ≤ 17 years, Non-Jews (minority), critical injuries (ISS 25–75), head injuries (AIS ≥ 3) and fall injuries were significantly more frequent among transfers, compared with the DA groups. Evacuation by emergency medical services was less frequent among transfers. After accounting for possible confounders, transfers had a greater risk of in-hospital mortality [DA to TCI vs transfer, OR (95% CI) 0.61 (0.52–0.72); DA to TCII vs transfer, OR (95% CI) 0.78 (0.65–0.94)]. In stratified analyses, these mortality differences persisted among the sub-group of patients who sustained critical injuries, among the patients with non-penetrating injuries, among the elderly ages ≥ 65 year and during the first 2 weeks of hospitalization. Conclusion: This study has intervention implications that should be directed primarily at prehospital triage and the inter-hospital transfer processes. In addition, there may be a need to optimize the capabilities of regional trauma systems along with continuous performance evaluations and actions as required. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the relative contributions of different mechanisms of assault to injury and mortality in women in Israel. Methods: We identified females hospitalized between 2011 and 2020 following an assault, secondary to blunt, stabbing, or shooting mechanisms of injury, in the Israeli Program for Registration of Trauma Patients (National Trauma Registry). To avoid bias due to temporary hospitalizations for non-medical reasons, we included patients with injuries graded as Abbreviated Injury Scale ≥ 2. Results: Females accounted for 8.1% (926/11,486) of assault patients in the study population. Compared to males, females were older (40.7 vs. 31.0 years; p < 0.001), more commonly injured by the blunt trauma mechanism (72.1 vs. 48.6%; p < 0.001), and more commonly injured at a place of residence (50.9 vs. 8.2%; p < 0.001). There were no differences in the number of body areas injured, severe Injury Severity Score, and median hospitalization. Males were operated more commonly (44.6 vs. 40.0%; p = 0.008). Mortality in females and males was similar (2.8 vs. 2.3%; p = 0.43). Secondary analysis revealed that blunt injuries were responsible for 61.2% of the severe cases (ISS ≥ 16), 61.4% of the operations, 54.9% of the Intensive Care Unit (ICU) admissions, and 53.8% of the mortality observed in females. When compared to males injured by blunt trauma, females injured by this mechanism were older (43.0 ± 24.7 vs. 32.8 ± 16.1 years; p < 0.001) and had higher mortality (2.1 vs. 0.9%; p = 0.007). Conclusions: Assault by mechanisms other than stabbing and shooting should be recognized as a source of severe morbidity and mortality in females. [ABSTRACT FROM AUTHOR]

Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15–29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery. [ABSTRACT FROM AUTHOR]

Purpose: Under-vehicle explosions caused by improvised explosive devices (IED) came to the public's attention during armed conflicts. However, IEDs are also used by criminals in the civilian setting. This study aimed to determine the pattern of injury, medical management, and outcomes of civilians injured during under-vehicle explosions caused by IEDs. Methods: This is a retrospective cohort study based on the Israeli National Trauma Registry of patients injured from under vehicle explosions caused by IEDs during 2006–2020. Injuries resulting from terror attacks and war were excluded. Descriptive statistics were used for data analysis. Results: During the study period, 58 incidents were recorded, resulting in 74 patients who arrived alive to the hospitals and 17 who died on scene. Seventy-one (95.9%) were male with a median age of 32 years (IQR 24–42). 42% were severely injured (ISS ≥ 16). There was an average of 2.4 injured regions per patient, with extremity injuries being the most common (70.3%). Face (34%), abdomen (28%), and chest (22%) injuries were frequent. 45% were immediately transferred to the operating theatre, and 72% underwent at least one operation. Orthopedic surgeries were the most common interventions. 27 amputations were performed. Conclusions: Injuries caused by under-vehicle IEDs in civilian settings differ from those caused by IEDs used during military conflicts or acts of terrorism: they are associated with fewer victims per incident, more severe injuries, more truncal injuries, and more lower extremity injuries requiring amputations. This can be attributed to the lack of personal and vehicle protection, and the different explosive types. [ABSTRACT FROM AUTHOR]

Background: Domestic violence against women, which is an ancient phenomenon, is still thriving worldwide. The burden of domestic violence that is non-fatal on scene and its consequences in Israel are unknown. The purpose of this study was to provide evidence-based data regarding domestic violence-related hospitalizations among women in Israel. Methods: The study is a retrospective cohort study of hospitalized patients included in the Israeli National Trauma Registry between January 1, 2011 and December 31, 2020. All women aged 14 and older, hospitalized due to a violence-related injury in one of the six-level I Trauma Centers or one of the 15 regional Trauma Centers in Israel were included (n = 676). Results: Domestic violence contributes to moderate, severe, and critical injuries in a quarter of abused hospitalized women. Among these women, 20% underwent surgery, and in-hospital mortality was recorded for 2% of the patients. For most cases (53%), the spouse or ex-spouse caused the injury. The family relationship with the perpetrator was distributed differently between the population groups. The proportion of brothers who attacked sisters was greatest among Arabs (14.4%), while the phenomenon of attacking a mother was infrequent in the Arab sub-group. In contrast, among Jewish women, the proportion of those injured by a son was high, especially among the group of Jewish immigrants from the Former Soviet Union (FSU) (17%) and other countries (26%). In a multivariable logistic regression model with at least moderate injury as a dependent variable, in comparison to Israeli Arabs, Jews had a higher odds for sustaining at least moderate injuries, while the odds of Jewish immigrants not from FSU or Ethiopia were the highest (OR = 4.5, 95% CI 2.0–9.9). The annual hospitalization risk was 1.3/100,000 and 5.8/100,000, respectively for Jews and Arabs in 2020, almost fivefold higher among Arab women in comparison to Jewish women (RR = 4.6, 95% CI 2.9–7.3). Conclusions: Domestic violence prevention should pay special attention to populations at risk, such as Arab women and new immigrants, as those women are especially vulnerable and often without sufficient family support and lack of economic resources to exit the trap of domestic violence. The collaboration between social and health services, the police, and the local authorities is crucial. [ABSTRACT FROM AUTHOR]

Background/Aim: Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. Methods: This historical prospective multi‐center study was based on Israel's Trauma Registry between 2008‐2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e‐bike/scooter), maxillofacial injury location, and maxillofacial treatment. Results: MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e‐bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0‐14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento‐alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. Conclusion: Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type. [ABSTRACT FROM AUTHOR]

Background: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC. Methods: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling. Results: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12–1.65) and TBI (OR = 1.51,95%CI = 1.12–1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12–0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00–1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61–0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39–0.7). In-hospital mortality was not associated with ethnicity. Conclusions: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance. [ABSTRACT FROM AUTHOR]

Background/aims: Electric-Powered Bikes and powered scooters present a new method of transportation and are becoming commonly used worldwide. However, the reports on traumatic dental injuries related to their use are scarce. The aim of this study was to report the frequency and severity of dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel between the years 2014 and 2019.Methods: This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. All injured patients who were hospitalized due to a traffic collision between 2014 and 2019 were identified. The data for those hospitalized due to an e-bike or motorized scooter accident were extracted as well as for pedestrians who were injured as a result of a crash with these vehicles.Results: A total of 3,686 hospital admissions were related to electric-powered bikes and scooters. Of those, 378 (10.3%) were oral and maxillofacial injuries. Most of the oral and maxillofacial injuries were attributed to powered bikes (321 out of 378; 84.92%) and the rest to powered scooters. There was a constant increase in general as well as the oral and maxillofacial injuries during the study years. Almost 20% of the cases involved injuries to the teeth. Overall, 291 pedestrians were reported to be injured due to electric-powered bikes and scooters; 29 (9.97%) of them, suffered from oral and maxillofacial injuries. Most of those were children aged 0-15 years (41.38%) and elders older than 60 years (37.39%).Conclusions: Trauma related to electric-powered bikes and scooters is an increasing concern. Dental professionals should be actively involved in educational and legislative efforts focusing on the prevention of e-bike and scooter-related injuries, in general, and specifically maxillofacial injuries. [ABSTRACT FROM AUTHOR]

Background: Most of the trauma patients who die in the first 24 h from arrival to the hospital do so as a result of haemorrhagic shock. Resuscitative endovascular balloon occlusion of the aorta (REBOA) facilitates expedient proximal aortic control, potentially bridging a needed gap for partial or non‐responders to traditional resuscitation en route to emergent definitive haemostasis. This resuscitation tool continues to evolve and has recently achieved some consensus defined indications for its use. The aim of this study is designed to examine the potential utility of REBOA among trauma victims who die within 24 h of arrival. Methods: Data of all trauma patients who died in the first 24 h, from 2012 to 2017 were extracted from the National Trauma Registry in the Gertner Institute for Epidemiology and Health Policy Research. Patients who died in the first half an hour, and those with neck and thorax injuries were excluded. Demographics, clinical and injury data were collected. Results: Overall, 129 patients were included; 74% male and 26% female with the mean age of 46.4 years. A total of 76% suffered blunt trauma and 24% penetrating trauma. Mean survival time was 5.87 h. The cause of death was major abdominal organ injury in 47.2%, injury to major abdominal vessel in 23.3% and pelvic fractures in 21.7%. A total of 69 patients (53.5%) ultimately required delayed resuscitative thoracotomy in the operation room. Conclusion: Registry data suggest that there is a subset of patients presenting to modern trauma centres who might benefit from REBOA in order to avoid death. [ABSTRACT FROM AUTHOR]

Purpose: This study was primarily aimed at establishing the incidence and impact of hypotension in patients with blunt traumatic brain injury based on National Trauma Registry Database., Methods: A retrospective cohort study using the National Trauma Registry was conducted. Patients with TBI following blunt mechanisms of injury were examined, comparing those with and without hypotension (SBP < 90 mm Hg) on arrival., Results: During the period from 1998 to 2017, the registry included 437.354 blunt trauma patients. Of them, 7818 patients were hemodynamically unstable (SBP < 90 mm Hg) on admission. 513 met the inclusion criteria. Significant percentages of patients with high grade injures (ISS≥16) and low admission's GCS 3-12 (46% vs 16.4%), were found in the group of hypotensive TBI patients (p<0.0001). 323 (62.9%) patients had head AIS score 3-4 and only 190 (37.1%) patients AIS 5-6 (p<0.0001). Mortality in the hypotensive TBI group was 32.3%, whereas 6.1% patients died in the TBI hemodynamically stable group (p<0.0001)., Conclusion: TBI patients presenting with hypotension represent an appreciable portion blunt trauma patients. Prompt brain CT, expedient efforts at optimal resuscitation and possibly early inotropic and vasopressors agents use may have an impact on final outcome in these patients.