Journal of Rehabilitation Medicine 51-3 | Page 79

J Rehabil Med 2019; 51: 225–233 ORIGINAL REPORT CLINICAL CHARACTERISTICS AND PHYSICAL FUNCTIONING IN PERSONS HOSPITALIZED FOLLOWING THE NORWEGIAN TERROR ATTACKS IN JULY 2011: A FOLLOW-UP STUDY Grethe MÅNUM, MD, PhD 1,2 *, Marianne LØVSTAD, Cand Psychol, PhD 1,3 , Kristin WISLØFF-AASE, MD 2,4 , Johan RÆDER, MD, PhD 2,4 , Anne Kristine SCHANKE, Cand Psychol, PhD 1,3 , Ingar Larsen, Cand Psychol 1 , Grete DYB, MD, PhD 2,5 , Øivind EKEBERG, MD, PhD 6,7 and Johan K. STANGHELLE, MD, PhD 1,2 From the 1 Department of Research, Sunnaas Rehabilitation Hospital, 2 Institute of Clinical Medicine, Faculty of Medicine, 3 Department of Psychology, University of Oslo, 4 Department of Anesthesiology, Oslo University Hospital, 5 Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, 6 Division of Mental Health and Addiction, Oslo University Hospital and 7 Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Objective: To describe the clinical characteristics and physical functioning in persons hospitalized af­ ter 2 terror attacks in Norway in 2011. Design: Cross-sectional study with retrospective acute medical data. Subjects: Surviving persons hospitalized with phy­ sical injuries. Methods: Medical and psychological assessments 3–4 years after injury, with data on injury type and severity collected from medical records. Results: A total of 30 out of 43 potential subjects participated (19 women, 11 men; age range 17–71 years (median 23 years)). Eighteen participants had suffered a severe injury, with New Injury Severity Scale (NISS) scores > 15. All body parts were affec­ ted. The number of surgical procedures ranged from 0 to 22 (median 3), and days in intensive care rang­ ed from 0 to 59 (median 2.5), of which 16 had more than 24 h intensive care. Three to 4 years later, a majority of the participants had a broad spectrum of somatic and psychological problems and reduced physical functioning. Two-thirds of the participants reported their physical health to be unsatisfacto­ ry, and continuous need for healthcare and unmet needs were identified for all except 4 of the parti­ cipants. Conclusion: Persons hospitalized following a terror attack experience a broad spectrum of somatic and psychological problems and need long-term physical and psychological follow-up. This study indicates specific needs for rehabilitation after injuries acqui­ red under psychological traumatic circumstances. Key words: terrorism; multiple trauma; health status; reha- bilitation. Accepted Jan 15, 2019; Epub ahead of print Feb 27, 2019 J Rehabil Med 2019; 51: 225–233 Correspondence address: Grethe Månum, Sunnaas Rehabilitation Hos- pital, Bjørnemyrvn. 11, 1450 Nesoddtangen, Norway. E-mail: grethe. [email protected] T error attacks can result in loss of life and large numbers of severely injured persons (1–6). Prior research after terrorist attacks has focused primarily LAY ABSTRACT Victims of terror are at major risk of long-term post- traumatic stress disorder (PTSD) and physical sequelae. Prior research after terrorist attacks has focused prima- rily on PTSD and the need for mental health services, where being injured has been seen as an indicator of high exposure to the traumatic event and a predictor of the level of psychological distress, rather than as a risk factor for function and healthcare needs. Similar to survivors of natural disasters, the impairments after terror attacks vary in severity, and might include spinal cord injuries, traumatic brain injury, limb amputation, fractures, soft-tissue injuries, and psychological seque- lae. This study investigated the medical characteristics, physical functioning, and life satisfaction of people hos- pitalized with physical injuries due to the 2011 Norway terror events approximately 3 years after the attacks. The assessments revealed a broad spectrum of somatic and psychological problems, reduced physical functio- ning, and a continuous need for healthcare. on post-traumatic stress disorder (PTSD) and other mental health issues and, correspondingly, the need for mental health services (7–10). To our knowledge, few studies have addressed long-term somatic health characteristics and physical functioning in physically injured terror victims. On 22 July 2011, an extremist attacked the Govern- mental Quarter in Oslo and a youth organization’s summer camp on Utøya Island, Norway, killing 77 people and severely injuring many others (1–3). Pre- vious studies on the injured survivors have focused on their acute medical treatment (2, 3). Many victims underwent multiple surgeries; 18 patients underwent 194 surgical procedures (3). The fragmenting bullets resulted in progressive necrosis and destruction of soft tissue with the risk of sepsis (3). These patients exhibi- ted repetitive debridement; tissue loss was among the primary challenges in the acute phase, and 2 patients were amputated at the elbow or ex-articulated at the shoulder and hip, respectively (3). The Norwegian Centre for Violence and Traumatic Stress has conducted a longitudinal survey investigating This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2521