Rehabilitation Outcomes of Terror Victims With Multiple Traumas

Abstract 

Schwartz I, Tsenter J, Shochina M, Shiri S, Kedary M, Katz-Leurer M, Meiner Z. Rehabilitation outcomes of terror victims with multiple traumas.

Objectives

To describe the rehabilitation outcomes of terror victims with multiple traumas, and to compare those outcomes with those of patients with nonterror-related multiple traumas treated in the same rehabilitation facility over the same time period.

Design

Retrospective chart reviews.

Setting

Rehabilitation department in a university hospital in Jerusalem, Israel.

Participants

Between September 2000 and September 2004, we treated 72 victims of terrorist attacks who had multiple traumas. Among them, 47 (65%) had multiple traumas without central nervous system involvement (MT subgroup), 19 (26%) had multiple traumas with traumatic brain injury (TBI subgroup), and 6 (8%) had multiple traumas with spinal cord injury (SCI subgroup). We matched, according to their types of injury and demographic data, each terror victim with a control patient treated in the same period in our rehabilitation department.

Intervention

Interdisciplinary inpatient and outpatient rehabilitation.

Main Outcome Measures

Hospital length of stay (LOS) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (FIM instrument score), occupational outcome (returning to previous occupation), and psychologic outcome (Solomon PTSD [post-traumatic stress disorder] Inventory).

Results

The mean LOS of terror victims was 218±131 days; for the nonterror group it was 152±114 days (P<.01). In comparison with the control subgroups, the MT subgroup of terrorist victims had significantly longer LOS in the acute care and outpatient rehabilitation departments (P=.06) and the terror TBI subgroup had a longer LOS in outpatient department only (P<.05). The LOS of the SCI patients, both terror victims and control patients, was significantly longer than that of the other 2 subgroups. The difference between FIM value at entry and discharge (ΔFIM) was significantly higher for terror victims than for the controls (41.1±21.6 vs 30.8±21.8, P=.002). This difference was mainly the result of the significantly higher ΔFIM achieved by the terror MT subgroup than by the MT controls. The rate of PTSD was higher among terror victims than among controls (40.9% vs 24.2%, P=.04). The rate of return to previous occupations was similar between terror victims and nonterror patients (53% vs 46.9%, respectively).

Conclusions

Victims of terror spent longer periods in rehabilitation than the nonterror group; however, they regained most activity of daily living functions similar to the nonterror group. Despite the higher rate of PTSD, terror victims succeeded in returning to their previous occupations at a similar rate to that of the nonterror group.

Key Words: Brain injuries, Multiple trauma, Rehabilitation, Spinal cord injuries, Stress disorders, post-traumatic, Terrorism, Treatment outcome