Citation

Arnold JL, Halpern P, Tsai MC, Smithline HA. Ann. Emerg. Med. 2004; 43(2): 263-273.

Affiliation

Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA. arnoldmdcs@cs.com

Copyright

(Copyright © 2004, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI

10.1016/S0196064403007236

PMID

14747818

Abstract

STUDY OBJECTIVE: We compared the epidemiologic outcomes of terrorist bombings that produced 30 or more casualties and resulted in immediate structural collapse, occurred within a confined space, or occurred in open air. METHODS: We identified eligible studies of bombings through a MEDLINE search of articles published between 1966 and August 2002 and a manual search of published references. Pooled and median rates of mortality, immediately injured survival, emergency department use, hospitalization, and injury were determined for each bombing type. RESULTS: We found 35 eligible articles describing 29 terrorist bombings, collectively producing 8,364 casualties, 903 immediate deaths, and 7,461 immediately surviving injured. Pooled immediate mortality rates were structural collapse 25% (95% confidence interval [CI] 6% to 44%), confined space 8% (95% CI 1% to 14%), and open air 4% (95% CI 0% to 9%). Biphasic distributions of mortality were identified in all bombing types. Pooled hospitalization rates were structural collapse 25% (95% CI 6% to 44%), confined space 36% (95% CI 27% to 46%), and open air 15% (95% CI 5% to 26%). Unique patterns of injury rates were found in all bombing types. CONCLUSION: Patterns of injury and health care system use vary with the type of terrorist bombing.