Background: The health effects of war and armed conflict on casualties and mental health of those directly\nexposed has been well described, but few studies have explored the indirect health effects of violent events. This\npaper assesses the indirect health impact of several violent events that took place in Beirut in 2013â??2014 on ED\nvisit utilization and disease patterns.\nMethods: As tracked by media reports, there were 9 violent events in Beirut during 2013â??2014. We compared visits\nto the Emergency Department of a major medical center during weeks when violent events happened and weeks\nwithout such events (the preceding week and the same week in preceding years). After re-coding de-identified\ndata from the medical records of 23,067 patients, we assessed differences in the volume of visits, severity index, and\ndischarge diagnoses. Individual control charts were used to analyze ED visit trends post-event.\nResults: Comparisons of weeks with violent events and weeks without such events indicate that the sociodemographic\ncharacteristics of patients who visited the Emergency Department were similar. Patients seen during\nviolent weeks were significantly more likely to be admitted to the hospital, and less likely to present with low acuity\ncomplaints, indicating greater complexity of their conditions. The discharge diagnoses that were significantly higher\nduring violent event weeks included anxiety disorders, sprains, and gastritis. Daily ED visits dropped post events by\n14.111%, p < 0.0001.\nConclusions: The results indicate that violent events such as bombs, explosions, and terrorist attacks reverberate\nthrough the population, impact patterns of ED utilization immediately post-event and are associated with adverse\nhealth outcomes, even among those who are not directly affected by the events.
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