title: The ins and outs of terrorist bus explosions: injury profiles of on-board explosions versus explosions occurring adjacent to a bus.
abstract: BACKGROUND
  Terrorist explosions occurring in varying settings have been shown to lead to significantly different injury patterns among the victims, with more severe injuries generally arising in confined space attacks. Increasing numbers of terrorist attacks have been targeted at civilian buses, yet most studies focus on events in which the bomb was detonated within the bus. This study focuses on the injury patterns and hospital utilisation among casualties from explosive terrorist bus attacks with the bomb detonated either within a bus or adjacent to a bus.
  
  
  METHODS
  All patients hospitalised at six level I trauma centres and four large regional trauma centres following terrorist explosions that occurred in and adjacent to buses in Israel between November 2000 and August 2004 were reviewed. Injury severity scores (ISS) were used to assess severity. Hospital utilisation data included length of hospital stay, surgical procedures performed, and intensive care unit (ICU) admission.
  
  
  RESULTS
  The study included 262 victims of 22 terrorist attacks targeted at civilian bus passengers and drivers; 171 victims were injured by an explosion within a bus (IB), and 91 were injured by an explosion adjacent to a bus (AB). Significant differences were noted between the groups, with the IB population having higher ISS scores, more primary blast injury, more urgent surgical procedures performed, and greater ICU utilisation. Both groups had percentages of nearly 20% for burn injury, had high percentages of injuries to the head/neck, and high percentages of surgical wound and burn care.
  
  
  CONCLUSIONS
  Explosive terrorist attacks detonated within a bus generate more severe injuries among the casualties and require more urgent surgical and intensive level care than attacks occurring adjacent to a bus. The comparison and description of the outcomes to these terrorist attacks should aid in the preparation and response to such devastating events.
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Golan
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
authors.forename: Adi
authors.initials: A
authors.lastname: Givon
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000401:mortality; D001336:Automobiles; D001753:Blast Injuries / Q000145:classification* / Q000401:mortality; D002056:Burns / Q000145:classification / Q000401:mortality*; D004636:Emergency Service, Hospital; D005107:Explosions / Q000145:classification; D005260:Female; D005547:Foreign Bodies / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000209:etiology* / Q000401:mortality; D016019:Survival Analysis; D023481:Terrorism; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000401:mortality; D014950:Wounds, Penetrating / Q000209:etiology / Q000401:mortality
keywords: Blast injury; Bus explosions; Explosive injury patterns; Terrorism