Skip to main content Accessibility help
×
Home

Traumatic Brain Injuries after Mass-Casualty Incidents: Lessons from the 11 September 2001 World Trade Center Attacks

  • Wesley Rutland-Brown (a1), Jean A. Langlois (a1), Leze Nicaj (a2), Robert G. Thomas (a3), Susan A. Wilt (a2) and Jeffrey J. Bazarian (a4)...

Abstract

Introduction:

The 11 September 2001 terrorist attacks on the World Trade Center (WTC) resulted in thousands of deaths and injuries. Research on previous bombings and explosions has shown that head injuries, including traumatic brain injuries (TBIs), are among the most common injuries.

Objective:

The objective of this study was to identify diagnosed and undiagnosed (undetected) TBIs among persons hospitalized in New York City following the 11 September 2001 WTC attacks.

Methods:

The medical records of persons admitted to 36 hospitals in New York City with injuries or illnesses related to the WTC attacks were abstracted for signs and symptoms of TBIs. Diagnosed TBIs were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Undiagnosed TBIs were identified by an adjudication team of TBI experts that reviewed the abstracted medical record information. Persons with an undiagnosed TBI were contacted and informed of the diagnosis of potential undetected injury.

Results:

A total of 282 records were abstracted. Fourteen cases of diagnosed TBIs and 21 cases of undiagnosed TBIs were identified for a total of 35 TBI cases (12% of all of the abstracted records). The leading cause of TBI was being hit by falling debris (22 cases). One-third of the TBIs (13 cases) occurred among rescue workers.More than three years after the event, four out of six persons (66.67%) with an undiagnosed TBI who were contacted reported they currently were experiencing symptoms consistent with a TBI.

Conclusions:

Not all of the TBIs among hospitalized survivors of the WTC attacks were diagnosed at the time of acute injury care. Some persons with undiagnosed TBIs reported problems that may have resulted from these TBIs three years after the event. For hospitalized survivors of mass-casualty incidents, additional in-hospital, clinical surveys could help improve pre-discharge TBI diagnosis and provide the opportunity to link patients to appropriate outpatient services. The use and adequacy of head protection for rescue workers deserves re-evaluation.

Copyright

Corresponding author

Jean A. Langlois, ScD, MPH CDC/NCIPC/DIR, 4770 Buford Highway, NE MS F-41, Atlanta, GA 30341-3724, USA E-mail: jal7@cdc.gov

References

Hide All
1.Peral-Gutierrez de Ceballos, J, Turegano-Fuentes, F, Perez-Diaz, D, et al. : 11 March 2004: The terrorist bomb explosions in Madrid, Spain–An analysis of the logistics, injuries sustained, and clinical management of casualties treated at the closest hospital. Crit Care 2005;9(1):104111.
2.Mallonee, S, Shariat, S, Stennies, G, et al. : Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA 1996;276(5):382387.
3.Frykberg, ER, Tepas, JJ: Terrorist bombings: Lessons learned from Belfast to Beirut. Ann Surg 1988;208(5):569576.
4.Scott, BA, Fletcher, JR, Pulliam, MW, Harris, RD: The Beirut terrorist bombing. Neurosurgery 1986;18(1):107110.
5.Buduhan, G, McRitchie, DI: Missed injuries in patients with multiple trauma. J Trauma 2000;49:600605.
6.Rizoli, SB, Boulanger, BR, McLellan, BA, Sharkey, PW: Injuries missed during initial assessment of blunt trauma patients. Accid Anal Prev 1994;26(5):681686.
7.Centers for Disease Control and Prevention (CDC): Deaths in World Trade Center terrorist attacks–New York City, 2001. MMWR 2002;51(special issue):1618.
8.CDC: Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center–New York City, September 2001. MMWR 2002;51(1):15.
9.Brackbill, RM, Thorpe, LE, DiGrande, L, et al. : Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. In: Surveillance Summaries, 07 April 2006. MMWR 2006;55(No SS-2):118.
10.Feeney, JM, Goldberg, R, Blumenthal, JA: September 11, 2001, revisited. Arch Surg 2005;140:10681073.
11.Frykberg, ER: Medical management of disasters and mass casualties from terrorist bombings: How can we cope? J Trauma 2002;53(2):201212.
12.Brooks, A, Holroyd, B, Riley, B. Missed injury in major trauma patients. Injury 2004;35(4):407410.
13.Soundappan, SVS, Holland, AJA, Cass, DT: Role of an extended tertiary survey in detecting missed injuries in children. J Trauma 2004;57(1):114118.
14.Houshian, S, Larsen, MS, Holm, C: Missed injuries in a Level I trauma center. J Trauma 2002;52(4):715719.
15.Janjua, KJ,Sugrue, M, Deane, SA: Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma 1998;44(6):10001007.
16.Enderson, BL, Reath, DB, Meadors, J, et al. : The tertiary trauma survey: A prospective study of missed injury. J Trauma 1990;30(6):666669.
17.Hirshberg, A, Holcomb, JB, Mattox, KL: Hospital trauma care in multiplecasualty incidents: A critical view. Ann Emerg Med 2001;37(6):647652.
18.Scott, SG, Vanderploeg, RD, Belanger, HG, Scholten, JD: Blast injuries: Evaluating and treating the postacute sequelae. Federal Pract 2005;22(1):6675.
19.Halpern, P, Tsai, MC, Arnold, JL, et al. : Mass-casualty, terrorist bombings: Implications for emergency department and hospital emergency response (Part II). Prehosp Disast Med 2003;18(3):235241.
20.Ponsford, J: Rehabilitation interventions after mild head injury. Curr Opin Neurol 2005;18(6):692697.
21.Ponsford, J, Willmott, C, Rothwell, A, et al. : Impact of early intervention on outcome following mild head injury in adults. J Neurol Neurosurg Psychiatry 2002;73(3):330332.
22.Ponsford, J, Willmott, C, Rothwell, A, et al. : Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics 2001;108(6):12971303.
23.Chesnut, RM, Carney, N, Maynard, H, et al. : Rehabilitation for traumatic brain injury. Evidence report no. 2 (Contract 290-97-0018 to Oregon Health Sciences University). Rockville, MD: Agency for Health Care Policy and Research. February 1999.
24.McAllister, TW, Sparling, MB, Flashman, LA, et al. : Differential working memory load effects after mild traumatic brain injury. Neuroimage 2001;14(5):10041012.
25.Alves, W, Macciocchi, SN, Barth, JT: Postconcussive symptoms after uncomplicated mild head injury. J Head Trauma Rehabil 1993;8(3):4859.
26.Englander, J, Hall, K, Stimpson, T, Chaffin, S: Mild traumatic brain injury in an insured population: Subjective complaints and return to employment. Brain Inj 1992;6(2):161166.
27.US Department of Health and Human Services: International Classification of Diseases, 9th Revision: Clinical Modification (ICD-9-CM). 3rd ed. Washington, DC: US Department Health and Human Services, 1989.
28.Marr, AL, Coronado, VG (eds): Central Nervous System Injury Surveillance Data Submission Standards–2002. Atlanta: US Department Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2004.
29.Bazarian, JJ, Veazie, P, Mookerjee, S, Lerner, B: Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes. Acad Emerg Med 2006;13:3138.
30.MacKenzie, E, Sacco, W: ICDMAP-90: A User's Guide. Baltimore: The Johns Hopkins University School of Public Health and Tri-Analytics, Inc, 1997.
31.American College of Surgeons Committee on Trauma: Advanced Trauma Life Support for Doctors (ATLS). 7th ed. Chicago: American College of Surgeons, 2004.
32.Biffl, WL, Harrington, DT, Cioffi, WG: Implementation of a tertiary trauma survey decreases missed injuries. J Trauma 2003;54(1):3844.
33.Hirshberg, A, Scott, BG, Granchi, T, et al. : How does casualty load affect trauma care in urban bombing incidents? A qualitative analysis. J Trauma 2005;58(4):686695.
34.CDC: (2003, July). J., Langlois and W., Rutland-Brown (Eds.). Mild traumatic brain injury in mass trauma events. Unpublished proceedings.
35.Groves, WA, Ramani, RV, Radmosky, MC, Flick, JP: Protecting first responders: Analysis of PPE guidelines distributed at the World Trade Center and Pentagon disaster sites. Professional Safety 2004;49(11):3141.
36.Jackson, BA, Peterson, DJ, Bartis, JT, et al. : Protecting Emergency Responders—Lessons Learned from Terrorist Attacks. Santa Monica: RAND Distribution Services, 2002.
37.Sample, PL, Darragh, AR: Perceptions of care access: The experience of rural and urban women following brain injury. Brain Inj 1998;12(10):855874.
38.Corrigan, JD,Whiteneck, G, Mellick, D: Perceived needs following traumatic brain injury. J Head Trauma Rehabil 2004;19(3):205216.
39.Arnold, JL,Halpern, P, Tsai, MC, Smithline, H: Mass casualty terrorist bombings: A comparison of outcomes by bombing type. Ann Emerg Med 2004;43:263273.
40.Arnold, JL, Tsai, MC, Halpern, P, et al. : Mass-casualty, terrorist bombings: Epidemiological outcomes, resource utilization, and time course of emergency needs (Part I). Prehosp Disast Med 2003;18(3):220234.

Keywords

Traumatic Brain Injuries after Mass-Casualty Incidents: Lessons from the 11 September 2001 World Trade Center Attacks

  • Wesley Rutland-Brown (a1), Jean A. Langlois (a1), Leze Nicaj (a2), Robert G. Thomas (a3), Susan A. Wilt (a2) and Jeffrey J. Bazarian (a4)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed