While the 11 September 2001 terrorist attacks resulted in thousands of deaths and injuries, some injuries remain undiagnosed. The May 2008 issue of Prehospital and Disaster Medicine presents a research study examining incidence of traumatic brain injuries among persons hospitalized in New York City following the 11 September 2001 attacks. Using medical records of persons admitted to 36 hospitals in New York City with injuries or illnesses related to the attacks, individuals diagnosed with traumatic brain injuries (TBI) were identified using diagnosis codes from the International Classification of Diseases (9th Revision). Undiagnosed TBIs were identified by an adjudication team of TBI experts that reviewed the abstracted medical record information. Persons suspected of having an undiagnosed TBI were subsequently contacted and informed of the diagnosis of potential undetected injury.
The results indicate that, of the 282 records that were examined, 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 total). The leading cause of TBI was being hit by falling debris (22 cases) and 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 were currently experiencing symptoms consistent with a TBI. The researchers conclude that not all cases of traumatic brain injury among hospitalized survivors of the 2001 attacks were identified at the time of acute injury care. Many individuals with undiagnosed cases were found to experience problems due to lack of effective diagnosis and treatment. The authors recommend additional clinical surveys be provided in-hospital for hospitalized survivors of mass-casualty incidents to help improve pre-discharge TBI diagnosis and refer patients to appropriate outpatient services. The use and adequacy of head protection for rescue workers also needs to be re-evaluated.
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