A total of 571 patients were flagged as Beirut blast casualties and their information retrieved from epic. Out of these 212 were excluded due to empty charts with no documentation (42), suture removal , wound check , cancelled visit , incomplete service , left without being seen , ED visit unrelated to blast (144). The total number of included patients with available documentation was 359.
Most casualties were adults (n = 343, 95.6%), while pediatrics (≥ 19 years of age) accounted for 4.4% (n = 16). The mean age at presentation was 42 ± 20 years, with a median of 39 years (Q1–Q3; 28–53). The vast majority were males (n = 201, 56%), of Lebanese nationality (n = 265, 73.8%), and single (n = 212, 59.1%). Initial vital signs were normal on all patients. Median (Q1–Q3) Systolic Blood Pressure was 126 mmHg (117–136); median diastolic blood pressure was 73 mmHg (67–80); median heart rate was 85 beats per minute (73–97); median respiratory rate is 18 breaths/min , and median temperature is 37 C (36.7–37.1).
Injury epidemiology, body system classification, and transport mode
The most frequent mechanism of injury encountered was a penetrating injury, accounting for 45.7% of presentations. This was followed by other blast-related injuries (30.4%) and blunt injuries (23.4%). The most affected anatomical location were the limbs, with the upper extremities more affected than the lower extremities (35.7 vs. 27.6%). This was followed by head and face injuries which accounted for about 20% each, thoracic injuries (8.4%), skin (7%), abdominal and pelvic injuries (5%), and neck injuries (3.1%). Observed injuries were cuts/open wounds (35.1%) and bruises (34.3%) as well as fractures (18.9%) and sprains, strains, and dislocations (6.1%) (Table 1).
Out of those with a known arrival mode (n = 181), 6.5% only were brought to the ED by emergency medical services (EMS), while 31% arrived by non-ems vehicles, and 13.4% came walking. About 13% of patients who arrived at our ED had some sort of prehospital care (3.9% by EMT, 3.3% by nurses and 5.6% of physicians). Two patients were transferred from other hospitals to our facility, but most arrived primarily at our ED (82.7%) (Table 1).
By body system classification, reported injuries were musculoskeletal (56); skin lacerations/foreign bodies (25); head (24) where patients had skull fractures, subarachnoid hemorrhage, brain herniation, and epidural hematoma; Eye Ear Nose and Throat (EENT) (24) where injuries included tympanic membrane rupture, globe rupture, complex facial fractures, others; lung/chest wall injuries , Abdominal , cardiac , Obstetric , and spine  (Table 2).
Medications, tests, and imaging findings
Most patients (n = 217, 60.4%) required imaging and 64% had positive findings. The most frequently administered medication was analgesics (38%), followed by anesthetics (35%) for rapid sequence intubation, antibiotics (31%), tetanus vaccine (31%), and fluids (28%). Blood and blood products were administered in 3.8% of cases. COVID-19 PCR test was positive in two patients (Table 3).
ED and OR procedures
For patients who underwent an emergent procedure, the most common procedure was endotracheal intubation (n = 18, 5%). Three patients required surgical airway (n = 3, 0.8%). The rest required chest tube insertion for tension pneumothorax decompression (n = 4, 1.1%), one required thoracotomy, and five patients required cardiopulmonary resuscitation. Almost a quarter of patients required surgical operations in the operating room (n = 85, 23.6%), most of which were on the upper extremity, followed by lower extremities, and head/face (Table 4).
Most patients (n = 206, 57.4%) were treated in the ED and discharged home, 18% (n = 65) required noncritical care admissions, 5.3% (n = 19) required critical care admissions, 0.6% (n = 2) transferred to another hospital, and 2.8% (n = 10) were dead on arrival. After admission, 3.6% died in the hospital and 93% of patients were discharged alive.
Most of admitted patients had no pre-existing disability (51%). Upon discharge, 49% had slight disability, 16% moderate disability, and about 0.6% a form of severe disability. There were 0.6% of patients remained in vegetative state. (Table 5).
Out of the total casualties, 16 (4.4%) patients were less than 19 years. 3 (18.6%) patients were intubated, 6 (1.6%) had fractures, 7 (1.9%) had minor wounds, and 2 (0.6%) had major penetrating wounds/burns that are more than 10%. All pediatric patients survived to hospital discharge.
The mean costs of ED care were $216.88 ± 236.6 with a median of $127.4 (81.43–293.5).