Post-Concussion Syndrome Following Blast Injury: A Cross-Sectional Study of Beirut Blast Casualties

The massive 2020 blast in Beirut, Lebanon, caused by improperly stored ammonium nitrate, was one of the most powerful non-nuclear explosions in history, Following the blast, head injuries emerged as a predominant presentation to the emergency department (ED). Blast-induced head injuries can lead to mild traumatic brain injuries (mTBI) mediated via primary blast overpressure without direct head trauma. The recovery process from mTBIs can be prolonged and affected by several factors. If symptoms persist for more than three months, patients should be evaluated for post-concussion syndrome (PCS). While clinical blast-injury studies have focused on repetitive blast exposure, this study evaluates a cohort exposed to a single blast. We hypothesized that a single blast exposure is sufficient to induce PCS symptoms similar to those exposed to repetitive blasts.

This cross-sectional study explores PCS in patients presenting to the ED of a tertiary-care center following the Beirut blast. Patients were identified through medical charts, contacted by phone, and consented to participate at least three months post-blast (beginning in November 2020). We used the Rivermead Post-Concussion Questionnaire (RPQ) to assess for PCS. We analyzed the association of PCS with patients and injury characteristics.

Of 370 patients presenting to the ED, 145 (58.5%) completed the study questionnaire. Mean age was 39.8 ± 15.4 years, and 40% were females. Head trauma (46.9%) was the most common presentation. A total of 112 patients (77.2%) met the criteria for PCS, with a median RPQ score of 25 (interquartile range 18.75). After adjusting for injury types and distance from the blast, younger patients (adjusted odds ratio [aOR] 0.972, 95% confidence interval [CI] 0.947-0.998) and females (aOR 2.836, 95% CI 1.114-7.220) were more likely to suffer from PCS.

Our study revealed a remarkably high prevalence of PCS among survivors of the Beirut blast, with younger individuals and females disproportionately affected. This highlights the need for age- and sex-specific rehabilitation and support programs. However, the study was limited by incomplete patients records and contact information, leading to the exclusion of a significant number of patients who initially presented to the ED. Ultimately, this study underscores the crucial role of robust public health preparedness and specialized care pathways against future large-scale catastrophes. Further assessment, including neurobiomarker evaluation, will be conducted on these survivors.