BLAST INJURIES - BUS VERSUS OPEN-AIR BOMBINGS - A COMPARATIVE-STUDY OF INJURIES IN SURVIVORS OF OPEN-AIR VERSUS CONFINED-SPACE EXPLOSIONS

Objectives: To compare injury patterns resulting from explosions in th e open air versus within confined spaces. Methods: Medical charts of 2 97 victims of four bombing events were analyzed. Two explosions occurr ed in the open air and two inside buses. Similar explosive devices wer e applied in all four incidents. The incidence of primary blast injuri es, significant penetrating trauma (Abbreviated Injury Scale score gre ater than or equal to 2), burns, Injury Severity Score, Revised Trauma Score, and mortality were compared between the two populations. Resul ts: A total of 204 casualties were involved in open-air bombings, 15 o f whom died (7.8%), Ninety-three victims were involved in bus bombings , 46 of whom died (49%). The difference in mortality rate was highly s ignificant, p < 0.00001. Primary blast injuries were observed in 25 an d 31 victims (34.2% and 77.5% of admitted victims), respectively (p = 0.00003). Median Injury Severity Score was 4 versus 18, respectively ( p < 0.0001). Conclusion: Explosions in confined spaces are associated with a higher incidence of primary blast injuries, with more severe in juries and with a higher mortality rate in comparison with explosions in the open air.