Factors associated with injury severity in Oklahoma City bombing survivors.
BACKGROUND
Terrorist bombings are an increasing source of violent death and injury worldwide. Injuries in building bombings have been previously reported in descriptive studies, but no comparative analyses have quantitatively assessed factors influencing the severity of nonfatal bombing injuries. The objective of this study was to identify personal and environmental risk factors for injury severity in the Oklahoma City bombing, on April 19, 1995.


METHODS
We conducted a retrospective comparative analysis of 509 nonfatally injured occupants of four buildings surrounding the detonation site. The source of data was the 1995 Oklahoma City Bombing database, a registry of all injuries and fatalities related to the bombing. Multivariable logistic regression was used to assess two outcomes: (1) medically-attended injury among injured occupants; and (2) hospital admission among occupants with medically attended injuries.


RESULTS
Increased odds of sustaining medically attended injuries were associated with being struck by flying glass (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI], 1.9-14.8) and location above the first floor of buildings (OR, 4.0; 95% CI, 1.4-11.7) after adjustment for other factors. Adjusted odds of hospital admission were associated with location in the collapsed region (AOR, 43.4; 95% CI, 4.4-434.1), being blown by the blast wind (AOR, 5.3; 95% CI, 2.1-13.8), and being trapped (AOR, 3.1; 95% CI, 1.2-7.7).


CONCLUSIONS
The severity of nonfatal injury in the Oklahoma bombing was primarily associated with structural and environmental factors. Improved architectural design may prevent many injuries in building bombings. These finding provide evidence for future injury prevention activities.
Glenshaw
Mary T
MT
Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. mglenshaw@cdc.gov
Vernick
Jon S
JS
Li
Guohua
G
Sorock
Gary S
GS
Brown
Sheryll
S
Mallonee
Sue
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054042:Bombs; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005160:Facility Design and Construction; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D023481:Terrorism; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*