This study aimed to evaluate the clinical characteristics, anatomical injury distribution, and mortality-related factors among patients presenting to an emergency department in the Middle East with explosive injuries resulting from terror attacks over a 10-year period.

This retrospective cohort study included 271 patients with explosion-related injuries admitted to a tertiary trauma center between January 1, 2015, and January 1, 2025. Data were extracted from electronic medical records using relevant ICD-10 codes and verified via blinded chart review. Injury severity was assessed using ISS, RTS, and SI scores. Clinical, laboratory, and outcome variables were analyzed. ROC analysis was performed to evaluate the prognostic performance of trauma scores.

A total of 36 patients (13 %) died during hospitalization. Non-survivors had significantly lower GCS and RTS scores, and higher ISS scores (p < 0.001). ICU admission, intubation, transfusion, and amputation rates were significantly higher among the deceased. RTS showed the highest predictive accuracy for mortality (AUC: 0.979), followed by ISS (AUC: 0.910). Optimal cut-off values for predicting mortality were RTS ≤8.5 and ISS ≥34.5. Both scores demonstrated strong associations with in-hospital mortality (p < 0.001).

Explosive injuries due to terror attacks result in substantial morbidity and mortality, particularly in cases involving central anatomical regions and high trauma severity. ISS and RTS are valuable tools for early prognostic assessment. Prompt triage, surgical intervention, and critical care support are essential for improving outcomes in such complex trauma scenarios.