Three-year clinical characteristics of hospitalized terror victims
testinal tract). More than two-thirds (n = 22, 73.3%)
had injuries to their extremities, and 12 had extremity
injuries as their primary injury. More than half of the
participants (n = 17, 56.7%) had major injuries to their
skin and subcutaneous tissues, but only 2 had this
type of injury as their only injury. Extremity injuries
resulted in 4 amputations in the subacute phase. All
of these were scored as AIS = 3, by definition the most
severe level of extremity injury.
Clinical characteristics 3–4 years after the terror
attacks
As shown in Table II, most participants had several
sequelae due to their initial injuries. Ten participants
had visual, cognitive, motor or sensory impairments
caused by injuries to their central or peripheral nervous
system. Four had amputations that included a finger,
an arm, a leg, or both an arm and a leg, respectively.
Nine participants had prominent soft-tissue defects
Table II. Clinical characteristics 3 years after the terror attacks
Median
[Q1,Q3] Range
Total learning trial 1–5, CVLT-II b 58 [49,65.8] 42–88
Delayed recall, CVLT-II 60 [50,65] 40–65
50 [47,53.5] 37–63
n
Neurological impairments
Cranial nerves (e.g. vision, smell, paresis/
paralysis) 4
Upper or lower limb muscle tone and strength 2
Bladder and bowl function
1
Peripheral nerve injury
Musculoskeletal impairments
Amputations upper limb, lower limb or both
6
13
3
1
9
6
3
Amputation finger
Trauma-related loss of muscle tissue
Trauma-related reduced muscle strength
Trauma-related reduced joint range of motion
Skin impairments
Scars from trauma and surgery procedures
29
Neuropsychological functioning (t-scores); (n = 26) a
Digit span, total score (WAIS-IV digit span tests)
Self report
Distress from scars (0–10 NRS)
0 [0,3]
Memory problems (RPQ) a,c
Unsatisfactory memory (RPQ ≥ 3)
Concentration problems (RPQ) a,c
Unsatisfactory concentration (RPQ ≥ 3)
Post-traumatic stress symptoms (PTSD-RI) d
7
PF SF-36 ≤ 86.4
Physical health (LSS) h
Unsatisfactory physical health (LSS ≤ 4)
Psychological health (LSS)
Unsatisfactory psychological health (LSS ≤4)
15 [7.8, 29.0]
1–51
3.0 [1.5, 5.5] 0–8
90 [63.8, 100] 0–100
13
4 [2, 5] 1–6
4 [3, 5] 1–6
22
17
Results measured only from subjects without brain injury (n = 26).
California Verbal Learning Test.
Rivermead Post Concussion Symptoms Questionnaire items on concentration
and memory.
d
Post-traumatic-stress-disorder-reaction-index.
e
Numeric rating scale (0–10).
f
Short Form Health Survey (SF-36) physical function scale (0–100).
g
Norwegian general populations SF-36 PF mean score, Garratt et al. (34).
h
Life Satisfaction scale (1–6).
b
c
(e.g. shoulder, arm, abdominal or lower limb muscles).
Trauma-related reduction of muscle strength and joint
range of motion were found in 6 and 3 participants,
respectively. All except one had skin injury from the
trauma and/or surgical procedures, manifesting as
scars that were accompanied by varying degrees of
complaints. Sixteen reported no complaints related to
their scars, while 10 of the participants reported dist-
ress at a level of 4 or higher, along with a preference
to cover up their scars.
As shown in Table II, the median [Q1, Q3 ] PTSD-
RI and pain values were 15 [7.8, 29.0] and 6.5 [3.3,
7.8] , respectively. Four participants were scored as
having clinical levels of PTS symptoms. Twenty-five
participants reported having pain in the week before
assessment, and 12 were considered to have clinically
significant pain (NRS pain > 3).
Two of the 4 participants with a brain injury scored
5 and 6 on the GOS-E, indicating moderate disability.
For the 26 participants with no brain injury, the nor-
mal results on tests of memory and attention were in
contrast to subjective experience of reduced concen-
tration and memory (Table II). Exploratory analyses
revealed no statistically significant correlation between
subjective cognitive complaints and test-performance
on CVLT-II or WAIS-IV Digit-span. However, signifi-
cant correlations were found with current pain levels
as well as symptoms of post-traumatic stress (r range,
0.45–0.74, all p < 0.02).
Most participants (n = 23) reported health problems,
and 7 reported more than one health problem. Twenty
persons had sustained injuries to the body area in which
they reported health problems. Examples of these pro-
blems were gastrointestinal disorders (e.g. abdominal
pain and flatulence), skin conditions (e.g. dysaesthesia,
itching and pain from the areas with soft-tissue defects
and/or scars), reduced lung capacity, tinnitus, and neu-
rological deficits already reported. Fourteen participants
reported health problems before the terror event, but
only 2 reported more than one health problem.
2.0 [1.0, 3.0] 0–4
14
Physical function (PF SF-36) f
g
0–9
2.0 [0.0, 2.3] 0–4
Mean pain severity last week (0–10 NRS) e
a
10
229
Physical function
Three participants had a Barthel ADL Index score below
4, reflecting the need for help in ADL. Thirteen partici-
pants presented a reduced SF-36 PF mean score (<86.4)
(30). Two-thirds specified limitations in vigorous
activities (e.g. running or heavy lifting), and one-third
limitations in lifting or carrying groceries or climbing
several flights of stairs. No statistical significant cor-
relations were detected between the SF-36 PF and
NISS (r = –0.306, p = 0.30) or SF-36 PF and PTSD-RI
(r = – 0.326, p = 0.079), but significant correlations were
found between SF-36 PF and pain (r = –0.61, p < 0.001).
J Rehabil Med 51, 2019