Aykut Öztürk1, Rahman Şenocak1, Şahin Kaymak2, Oğuz Hançerlioğulları1, Süleyman Utku Çelik1, Nazif Zeybek2

1Department of General Surgery, Health Sciences University Gülhane Training and Research Hospital, Ankara, Turkey
2Division of War Surgery, Health Sciences University Gülhane Training and Research Hospital, Ankara, Turkey


Objective: Improving the care of injuries resulting from terrorist attacks requires understanding injury mechanisms in armed conflicts. The aim of this study was to identify injury characteristics in military personnel with thoracoabdominal combat injuries resulting from terrorist attacks in urban settings.

Material and Methods: A retrospective study of military personnel with thoracoabdominal injuries who were referred to a tertiary center after treating and stabilizing at a primary healthcare organization due to terror-related injuries in various urban regions of Turkey between June 2015 and December 2016 was performed.

Results: A total of 70 patients were included in this study, of whom 87.1% were injured by explosives and 12.9% (n= 9) had gunshot wounds (GSWs). Mean injury severity score (ISS) was 21, blood transfusion amount was 3.7 units, and mortality rate was 8.5%. Patients injured by explosives had most commonly abdominal and extremity injuries (31.1%), whereas isolated abdominal injuries (55.6%) were observed among patients with GSWs. There were no significant differences between the mechanisms of injuries and the ISS, blood transfusion, and mortality (p= 0.635, p= 0.634, and p= 0.770, respectively). A significant correlation was observed between the ISS and transfusion amounts (r= 0.548, p< 0.001). Mortality was significantly higher in those with a high ISS and those undergoing massive blood transfusions (p= 0.004 and p< 0.001, respectively).

Conclusion: Explosive injuries, concomitant vascular injuries, high ISS, and the need for massive transfusions increased the mortality rate in urban combat injuries. To quickly identify high-risk patients and improve the care of injuries, it is essential to use predictive models or scoring systems.

Keywords: Combat injury, injury severity score, thoracoabdominal injury, terrorism, urban

Cite this article as: Öztürk A, Şenocak R, Kaymak Ş, Hançerlioğulları O, Çelik SU, Zeybek N. Injury mechanisms and injury severity scores as determinants of urban terrorism-related thoracoabdominal injuries. Turk J Surg 2022; 38 (1): 67-73.


Ethics Committee Approval

The ethical approval for this study was obtained from the Non-invasive Clinical Researches Ethics Committee of the University of Health Sciences (Date: 16.01.2018, Decision No: 17/22).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - O.H., N.Z.; Design - A.O., R.S., O.H., N.Z.; Supervision - R.S., O.H., N.Z.; Materials - A.O., R.S., S.K., O.H., N.Z.; Data Collection and/or Processing - A.O., R.S., S.K., O.H., S.U.C.; Analysis and/or Interpretation - A.O., R.S., S.K., S.U.C.; Literature Search - A.O., R.S., S.K., O.H., S.U.C.; Writing Manuscript - All of authors; Critical Reviews - All of authors.

Conflict of Interest

The authors declare that they have no conflict of interest

Financial Disclosure

The authors declared that this study has received no financial support.