BACKGROUND The health effects of war and armed conflict on casualties and mental health of those directly exposed has been well described, but few studies have explored the indirect health effects of violent events. This paper assesses the indirect health impact of several violent events that took place in Beirut in 2013-2014 on ED visit utilization and disease patterns. METHODS As tracked by media reports, there were 9 violent events in Beirut during 2013-2014. We compared visits to the Emergency Department of a major medical center during weeks when violent events happened and weeks without such events (the preceding week and the same week in preceding years). After re-coding de-identified data from the medical records of 23,067 patients, we assessed differences in the volume of visits, severity index, and discharge diagnoses. Individual control charts were used to analyze ED visit trends post-event. RESULTS Comparisons of weeks with violent events and weeks without such events indicate that the socio-demographic characteristics of patients who visited the Emergency Department were similar. Patients seen during violent weeks were significantly more likely to be admitted to the hospital, and less likely to present with low acuity complaints, indicating greater complexity of their conditions. The discharge diagnoses that were significantly higher during violent event weeks included anxiety disorders, sprains, and gastritis. Daily ED visits dropped post events by 14.111%, p < 0.0001. CONCLUSIONS The results indicate that violent events such as bombs, explosions, and terrorist attacks reverberate through the population, impact patterns of ED utilization immediately post-event and are associated with adverse health outcomes, even among those who are not directly affected by the events.

中文翻译：

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暴力事件对应急部门的利用和疾病模式的间接影响。

背景技术已经很好地描述了战争和武装冲突对直接暴露者的人员伤亡和心理健康的健康影响，但是很少有研究探讨暴力事件的间接健康影响。本文评估了2013-2014年在贝鲁特发生的几起暴力事件对急诊就诊利用和疾病模式的间接健康影响。方法根据媒体报道，贝鲁特在2013-2014年期间发生了9起暴力事件。我们比较了发生暴力事件的几周和没有发生此类事件的几周（前几年的前一周和前几年的同一周）对主要医疗中心急诊科的访问。重新编码来自23,067例患者的病历的身份数据后，我们评估了就诊量，严重程度指数和出院诊断的差异。个别对照图用于分析事件后急诊就诊趋势。结果比较了发生暴力事件的几周和未发生暴力事件的几周，这表明去急诊室就诊的患者的社会人口统计学特征是相似的。在暴力周期间见过的患者入院的可能性显着更高，而对急性敏锐度的抱怨也不太可能出现，这表明病情更加复杂。在暴力事件几周内，出院率明显更高，包括焦虑症，扭伤和胃炎。每日ED访视使事件后减少14.111％，p <0.0001。结论结果表明，炸弹，爆炸和恐怖袭击等暴力事件在整个人群中回荡，