The burden of blast injuries on a level i trauma center: a comparative analysis of blast versus blunt trauma

PURPOSE: We hypothesized that blast trauma results in a greater institutional resource burden than blunt trauma. METHODS: This retrospective study compared blast trauma patients (N = 321) to blunt trauma patients (N = 9,172). A Propensity Score Matching (PSM) on Age, Sex and Injury Severity Score (ISS) was executed, yielding 1,481 matched blunt controls. The primary composite endpoint was Institutional Resource Burden, defined as requiring one or more of the following high-intensity resource metrics: prolonged hospital length of stay (LOS >7 days), ICU admission, or need for urgent surgical intervention (<6 hours from admission). Secondary endpoints included in-hospital mortality, shock-trauma room triage, any surgical intervention, multiple operations (≥ 3), massive transfusion protocol (MTP) activation, requirement for mechanical ventilation, and ICU/hospital LOS. RESULTS: Blast patients demonstrated a higher rate of the primary composite institutional burden (78.2 vs. 51.2, OR = 3.42, 95% CI: 2.59 - 4.51, p <0.0001). Blast mechanism independently predicted shock-trauma room triage (OR = 10.60, 95% CI: 8.18 - 13.75, p <0.0001), urgent surgery (OR = 7.49, 95% CI: 5.73 - 9.80, p <0.0001), ≥3 operations (OR = 12.40, 95% CI: 8.59 - 17.90, p <0.0001), MTP activation (OR = 11.68, 95% CI: 6.48 - 21.05, p <0.0001), and ICU admission (OR = 5.54, 95% CI: 4.37 - 7.04, p <0.0001). These differences persisted across both ISS <16 and ISS ≥16 strata. CONCLUSION: Blast trauma imposes a significantly higher institutional resource burden than blunt trauma across all injury severity strata.