title: Injury pattern of suicide bomb attacks in Pakistan.
abstract: OBJECTIVE
  The aim of our study was to analyze the pattern of injuries, hospital care, and outcome of the victims of suicide bomb attacks in Pakistan.
  
  
  METHODS
  This prospective, cohort study was conducted at the Combined Military Hospital Rawalpindi during the last 3 years. Seriously injured patients in the "immediate category" were resuscitated in the emergency operation theater adjacent to the emergency room and, after resuscitation, the patients were transferred to the main operation theaters, where consultant surgeons were available.
  
  
  RESULTS
  During the study period, 1,296 terrorist victims presented to the emergency department and (86.9%) were admitted, with a mean hospital stay of 8.2 ± 2.1 days. The majority of patients arrived by ambulance (91%) and only 38 (3%) were evacuated by air. Penetrating splinter injuries were the most prevalent (87%), and 29% patients also had associated injuries. Open bone fractures were found in 48% and 42% had injured hollow and solid viscous. Overall, 33% of patients had thoracic injuries and neuro-trauma was observed in 16% of the study population. Deafness was a feature in 33% patients, 121 had to undergo limb amputations, and mortality remained in 7% of patients.
  
  
  CONCLUSIONS
  Most of the problems encountered were logistic in nature. Early evacuation of the victims remains pivotal in saving lives. The major causes of death in peripheral patients was hypovolemic shock, sepsis, and hypothermia. Mortality and morbidity can be enhanced by ample fluid resuscitation, tetanus prophylaxis, and proficient first aid at the site of injury.
authors.affiliation: Department of General Surgery, Combined Military Hospital, Rawalpindi, 4600, Pakistan. dramjidyasin@gmail.com.
authors.forename: M M A
authors.initials: MM
authors.lastname: Yasin
authors.affiliation: Department of Gynecology and Obstetrics, Military Hospital Rawalpindi, Rawalpindi, 4600, Pakistan.
authors.forename: G
authors.initials: G
authors.lastname: Nasreen
authors.affiliation: Department of General Surgery, Combined Military Hospital, Rawalpindi, 4600, Pakistan.
authors.forename: S A
authors.initials: SA
authors.lastname: Malik
keywords: Injuries; Morbidity; Pakistan; Shock; Suicide bombs; Terrorism
references.citation: Med Trop (Mars). 2005;65(2):117-20
references.pmid: 16038346
references.citation: Am J Respir Crit Care Med. 2003 Sep 1;168(5):549-55
references.pmid: 12842857
references.citation: Ann Surg. 1988 Nov;208(5):569-76
references.pmid: 3056287
references.citation: Ann Surg. 2004 Mar;239(3):295-303
references.pmid: 15075644
references.citation: Am J Emerg Med. 2003 Jul;21(4):258-62
references.pmid: 12898479
references.citation: Prehosp Disaster Med. 2005 Nov-Dec;20(6):420-2
references.pmid: 16496627
references.citation: Emerg Med J. 2007 Jan;24(1):22-4
references.pmid: 17183037
references.citation: Ann Surg. 2004 Mar;239(3):319-21
references.pmid: 15075647
references.citation: J Trauma. 2002 Aug;53(2):201-12
references.pmid: 12169923
references.citation: Anesth Prog. 1999 Winter;46(1):10-20
references.pmid: 10551055
references.citation: Surg Clin North Am. 1999 Dec;79(6):1537-52
references.pmid: 10625992
references.citation: Acad Emerg Med. 1996 Jun;3(6):598-604
references.pmid: 8727631
references.citation: Ann Surg. 2004 Mar;239(3):322-4
references.pmid: 15075648
references.citation: Prehosp Disaster Med. 2005 Nov-Dec;20(6):368-77
references.pmid: 16496615
references.citation: Ann Emerg Med. 2001 Jun;37(6):664-78
references.pmid: 11385339
references.citation: Crit Care. 2005 Feb;9(1):104-11
references.pmid: 15693992
references.citation: Curr Opin Anaesthesiol. 2004 Apr;17(2):151-7
references.pmid: 17021544
references.citation: N Engl J Med. 2005 Mar 31;352(13):1335-42
references.pmid: 15800229
references.citation: J Am Coll Surg. 2006 Feb;202(2):313-9
references.pmid: 16427558
references.citation: J Trauma. 1999 Oct;47(4):728-32
references.pmid: 10528609
references.citation: Chest. 1999 Jan;115(1):165-72
references.pmid: 9925079
references.citation: J Trauma. 1996 Dec;41(6):1030-5
references.pmid: 8970558