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Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy-based case-control study on 4895 fatalities. Arch Orthop Trauma Surg 2022; 142:2645-2658. [PMID: 34196773 DOI: 10.1007/s00402-021-03997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The course of road traffic collision (RTC) victims with femoral fractures (FFx) from injury to death was reviewed. We sought to correlate the presence of femoral fractures with the overall severity of injury from RTCs using objective indices and to identify statistically significant associations with injuries in other organs. PATIENTS AND METHODS A case-control study based on forensic material from 4895 consecutive RTC-induced fatalities, between 1996 and 2005. Injuries were coded according to the Abbreviated Injury Scale-1990 Revision (AIS-90), and the Injury Severity Score (ISS) was calculated. Victims were divided according to the presence of femoral fractures in all possible anatomic locations or not. Univariate comparisons and logistic regression analysis for probabilities of association as odds ratios (OR) were performed. RESULTS The FFx group comprised 788 (16.1%) victims. The remaining 4107 victims constituted the controls. The FFx group demonstrated higher ISS (median 48 vs 36, p < 0.001) and shorter post-injury survival times (median 60 vs 85 min, p < 0.001). Presence of bilateral fractures (15.5%) potentiated this effect (median ISS 50 vs 43, p = 0.006; median survival time 40 vs 65, p = 0.0025; compared to unilateral fractures). Statistically significant associations of FFx were identified with AIS2-5 thoracic trauma (OR 1.43), AIS2-5 abdominal visceral injuries (OR 1.89), AIS1-3 skeletal injuries of the upper (OR 2.7) and lower limbs (OR 3.99) and AIS2-5 of the pelvis (OR 2.75) (p < 0.001). In the FFx group, 218 (27.7%) victims survived past the emergency department and 116 (53.2%) underwent at least one surgical procedure. Complications occurred in 45.4% of hospitalized victims, the most common being pneumonia (34.8%). CONCLUSION This study has documented that femoral fractures are associated with increased severity of injury, shorter survival times and higher incidence of associated thoracic, abdominal and skeletal extremity injuries, compared to controls. These findings should be considered for an evidence-based upgrading of trauma care.
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Xu S, Shi B, Yuxian J, He M, Yang P, Xu W, Liu G, Song Z, Du X, Wang D. Comparative Analysis of the Wounded in Patients and Deaths in a Hospital Following the Three Major Earthquakes in Western China. Front Public Health 2022; 10:775130. [PMID: 35875049 PMCID: PMC9304578 DOI: 10.3389/fpubh.2022.775130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to analyze the injury characteristics of patients and therapeutic strategies for patients injured in the last three big earthquakes in China, so as to provide a reference for the improvement of emergency plans for earthquakes. The analysis was based on the data provided by the Mianyang Central Hospital (MCH) from May 12th, 2008 to September 26th, 2017. Microsoft EXCEL software was used for data input, and SPSS was used for statistical analysis. A total of 1,390 earthquake-related patients were hospitalized in MCH. Most patients were admitted to the hospital within the first 2 weeks after the earthquake. The main causes for seismic injuries involved hit/strike by objects or building collapse /burying. Extremity fractures accounted for most injuries, especially 3 days after an earthquake. But soft tissue injuries cannot be neglected. Most earthquake patients were mainly treated by means of surgery and the majority were related to orthopedics. We found that different areas, population, and religions needed a tailored approach to the rescue effort. Therefore, the earthquake magnitude scale has a significant influence on mechanisms, types and severity of the injury of patients injured in earthquakes, as well as their timely transfer, management, and prognosis. Traumatic injuries are very common and thereby various surgical procedures especially orthopedic and neurosurgery are the domain of treatment modalities. Disaster preparedness and combined surgical team effort need to be focused on to reduce both mortality and morbidity.
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Affiliation(s)
- Shan Xu
- Department of Disaster Medicine Research Group, MianYang Central Hospital, Mianyang, China
- Shan Xu
| | - Bo Shi
- Department of Orthopedics, MianYang Central Hospital, Mianyang, China
| | - Jianbo Yuxian
- Deparment of General Surgery, MianYang Central Hospital, Mianyang, China
| | - Mei He
- Department of Nursing, MianYang Central Hospital, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, MianYang Central Hospital, Mianyang, China
| | - Weiyun Xu
- Department of Breast Surgery, MianYang Central Hospital, Mianyang, China
| | - Gang Liu
- Department of Orthopedics, MianYang Central Hospital, Mianyang, China
| | - Zhongjin Song
- Department of Science and Education, MianYang Central Hospital, Mianyang, China
| | - Xiaobo Du
- Department of Disaster Medicine Research Group, MianYang Central Hospital, Mianyang, China
- *Correspondence: Xiaobo Du
| | - Dong Wang
- Deparment of General Surgery, MianYang Central Hospital, Mianyang, China
- Dong Wang
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Álvarez-Díaz JA. Gender, disasters and mortality: Earthquake in Mexico City, September 19th, 2017. CIENCIA & SAUDE COLETIVA 2020; 25:2831-2836. [PMID: 32667564 DOI: 10.1590/1413-81232020257.30802018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022] Open
Abstract
This paper aimed to explain why more women died in the earthquake of September 19, 2017, in Mexico City. We adopted a mixed quantitative-qualitative method, with epidemiological and statistical data and a hemerographic review about the influence of gender on earthquake-derived mortality. In the quantitative part, the results show that the difference in deaths among women compared to those among men cannot be attributed to population distribution or randomization issues. In the qualitative part, the results show that many data are evidencing that gender is an essential social determinant that can explain why more women die than men after an earthquake. Therefore, we recommend that these data be considered responsibly to improve future prevention and intervention actions.
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Affiliation(s)
- Jorge Alberto Álvarez-Díaz
- Departamento de Atención a la Salud, UAM Xochimilco. Calzada del Hueso 1100, Col. Villa Quietud, Del. Coyoacán. 04960 Ciudad de México México.
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Prionas A, Tsoulfas G, Tooulias A, Papakoulas A, Piachas A, Papadopoulos V. Evaluating trauma care, outcomes and costs in a system in crisis: the necessity of a Greek National Trauma Database. Trauma Surg Acute Care Open 2020; 5:e000401. [PMID: 32373714 PMCID: PMC7193741 DOI: 10.1136/tsaco-2019-000401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/21/2020] [Accepted: 02/13/2020] [Indexed: 02/05/2023] Open
Abstract
Background At present there is no organized trauma system in Greece and no national trauma database. The objective of this study was to record and evaluate trauma management at our university hospital and to measure the associated healthcare costs, while laying the foundations for a national database and the organization of regional trauma networks. Methods Retrospective study of trauma patients (n=2320) between 2014 and 2015, through our single-center registry. Demographic information, injury patterns, hospital transfer, investigations, interventions, duration of hospitalization, Injury Severity Score (ISS), outcomes, complications and cost were recorded. Results Road traffic collisions (RTC) accounted for 23.2% of traumas. The proportion of patients who were transferred to the hospital by the National Emergency Medical Services decreased throughout the study (n2015=76/1192 (6.38%), n2014=109/1128 (9.7%)) (p<0.05). 1209 (52.1%) of our trauma patients did not meet the US trauma field triage algorithm criteria. Overtriage of trauma patients to our facility ranged from 90.7% to 96.7%, depending on the criteria used (clinical vs. ISS criteria). Ninety-one (3.9%) of our patients received operative management. Intensive care unit admissions were 21 (0.1%). Seventy-six (3.3%) of our patients had ISS>15 and their mortality was 31.6%. The overall non-salary cost for trauma management was €623 140. 53% of these costs were attributed to RTCs. The cost resulting from the observed overtriage ranged from €121 000 to €315 000. Patients who did not meet the US trauma triage algorithm criteria accounted for 10.5% of total expenses. Discussion Our results suggest that RTCs pose a significant financial burden. The prehospital triage of trauma patients is ineffective. A reduction of costs could have been achieved if prehospital triage was more effective. Level of evidence Level IV.
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Affiliation(s)
- Apostolos Prionas
- General Surgery, Queen's Hospital, Barking Havering and Redbridge Univesity Hospitals NHS Trust, Romford, London, UK.,Surgery and Cancer, Imperial College London, London, UK.,First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George Tsoulfas
- First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Andreas Tooulias
- First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Apostolos Papakoulas
- First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Athanasios Piachas
- First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasileios Papadopoulos
- First General Surgery Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Hydrogeological and Climatological Risks Perception in a Multi-Hazard Environment: The Case of Greece. WATER 2019. [DOI: 10.3390/w11091770] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate-related hazards, such as wildfires and hydrogeological phenomena, cause extensive damages and casualties around the world. Despite the recent advances and technologies for risk mitigation, it is acknowledged that public risk perception is a critical factor for these tools to succeed. Greece and the broader Eastern Mediterranean is an area where, despite the diversity of natural disasters, there is a lack of understanding of the hazard types that people are most concerned with and how they measure against other groups of hazards (i.e., geophysical). This work uses an online survey targeting Greek people, aiming to provide a better understanding of their perception of different natural hazards. Statistical results show that people consider climate-related hazards less dangerous and likely to occur than earthquakes, which occur often as zero-impact events. Laymen may thus underestimate certain risks, which may inhibit appropriate preparation. Disaster experience was found to increase threat perceptions and to motivate preparedness. However, in what concerns climate-related hazards, the effect of experience may fade out over time. Awareness activities were found to associate with higher emergency response efficacy. Males exhibit lower risk perception and higher coping appraisals. However, prioritization of risks is almost identical between genders. Implications for risk management are discussed.
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Abstract
OBJECTIVE Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand. METHODS The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores. RESULTS Significantly more females than males were injured or killed in the entire population of casualties (P20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured. CONCLUSION Where people were and what they were doing at the time of the earthquake influenced their risk of injury.
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Abstract
Background Hurricane Sandy made landfall in New Jersey (NJ) on October 29, 2012. We studied the impact of this extreme weather event on the incidence of, and 30‐day mortality from, cardiovascular (CV) events (CVEs), including myocardial infarctions (MI) and strokes, in NJ. Methods and Results Data were obtained from the MI data acquisition system (MIDAS), a database of all inpatient hospital discharges with CV diagnoses in NJ, including death certificates. Patients were grouped by their county of residence, and each county was categorized as either high‐ (41.5% of the NJ population) or low‐impact area based on data from the Federal Emergency Management Agency and other sources. We utilized Poisson regression comparing the 2 weeks following Sandy landfall with the same weeks from the 5 previous years. In addition, we used CVE data from the 2 weeks previous in each year as to adjust for yearly changes. In the high‐impact area, MI incidence increased by 22%, compared to previous years (attributable rate ratio [ARR], 1.22; 95% confidence interval [CI], 1.16, 1.28), with a 31% increase in 30‐day mortality (ARR, 1.31; 95% CI, 1.22, 1.41). The incidence of stroke increased by 7% (ARR, 1.07; 95% CI, 1.03, 1.11), with no significant change in 30‐day stroke mortality. There were no changes in incidence or 30‐day mortality of MI or stroke in the low‐impact area. Conclusion In the 2 weeks following Hurricane Sandy, there were increases in the incidence of, and 30‐day mortality from, MI and in the incidence of stroke.
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Affiliation(s)
- Joel N Swerdel
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.N.S., N.M.C., J.B.K.) Department of Epidemiology, Rutgers University School of Public Health, Piscataway, NJ (J.N.S., T.M.J.)
| | - Teresa M Janevic
- Department of Epidemiology, Rutgers University School of Public Health, Piscataway, NJ (J.N.S., T.M.J.)
| | - Nora M Cosgrove
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.N.S., N.M.C., J.B.K.)
| | - John B Kostis
- The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.N.S., N.M.C., J.B.K.)
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Berran PJ, Mazuchowski EL, Marzouk A, Theodore Harcke H. Observational Case Series: An Algorithm Incorporating Multidetector Computed Tomography in the Medicolegal Investigation of Human Remains after a Natural Disaster. J Forensic Sci 2014; 59:1121-5. [DOI: 10.1111/1556-4029.12422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/26/2013] [Accepted: 05/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Philip J. Berran
- Armed Forces Medical Examiner System; 115 Purple Heart Drive Dover Air Force Base Dover DE 19902
| | - Edward L. Mazuchowski
- Armed Forces Medical Examiner System; 115 Purple Heart Drive Dover Air Force Base Dover DE 19902
| | - Abubakr Marzouk
- Armed Forces Medical Examiner System; 115 Purple Heart Drive Dover Air Force Base Dover DE 19902
| | - H. Theodore Harcke
- American Registry of Pathology (A Contractor Supporting the Armed Forces Medical Examiner System); 115 Purple Heart Drive Dover Air Force Base Dover DE 19902
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Macintyre AG, Barbera JA, Petinaux BP. Survival Interval in Earthquake Entrapments: Research Findings Reinforced During the 2010 Haiti Earthquake Response. Disaster Med Public Health Prep 2013; 5:13-22. [PMID: 21357474 DOI: 10.1001/dmp.2011.5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
ABSTRACTEarthquakes can result in collapsed structures with the potential to entrap individuals. In some cases, people can survive entrapment for lengthy periods. The search for and rescue of entrapped people is resource intensive and competes with other postdisaster priorities. The decision to end search and rescue activities is often difficult and in some cases protracted. Medical providers participating in response may be consulted about the probability of continued survival in undiscovered trapped individuals. Historically, many espouse a rigid time frame for viability of entrapped living people (eg, 2 days, 4 days, 14 days). The available medical and engineering data and media reports demonstrate a wide variety in survival “time to rescue,” arguing against the acceptance of a single time interval applicable to all incidents. This article presents historical evidence and reports from the 2010 Haiti earthquake. Factors that may contribute to survival after entombment are listed. Finally, a decision process for projecting viability that considers the critical factors in each incident rather than adhering to a single time frame for ceasing search and rescue activities is proposed. (Disaster Med Public Health Preparedness. 2011;5:13–22)
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Affiliation(s)
- Anthony G Macintyre
- The George Washington University, 2150 Pennsylvania Ave, NW, Suite 2B, Washington, DC 20037, USA.
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Agapiou A, Mikedi K, Karma S, Giotaki ZK, Kolostoumbis D, Papageorgiou C, Zorba E, Spiliopoulou C, Amann A, Statheropoulos M. Physiology and biochemistry of human subjects during entrapment. J Breath Res 2013; 7:016004. [DOI: 10.1088/1752-7155/7/1/016004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Alexander D, Magni M. Mortality in the l'aquila (central Italy) earthquake of 6 april 2009. PLOS CURRENTS 2013; 5:e50585b8e6efd1. [PMID: 23326762 PMCID: PMC3541886 DOI: 10.1371/50585b8e6efd1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper presents the results of an analysis of data on mortality in the magnitude 6.3 earthquake that struck the central Italian city and province of L'Aquila during the night of 6 April 2009. The aim is to create a profile of the deaths in terms of age, gender, location, behaviour during the tremors, and other aspects. This could help predict the pattern of casualties and priorities for protection in future earthquakes. To establish a basis for analysis, the literature on seismic mortality is surveyed. The conclusions of previous studies are synthesised regarding patterns of mortality, entrapment, survival times, self-protective behaviour, gender and age. These factors are investigated for the data set covering the 308 fatalities in the L'Aquila earthquake, with help from interview data on behavioural factors obtained from 250 survivors. In this data set, there is a strong bias towards victimisation of young people, the elderly and women. Part of this can be explained by geographical factors regarding building performance: the rest of the explanation refers to the vulnerability of the elderly and the relationship between perception and action among female victims, who tend to be more fatalistic than men and thus did not abandon their homes between a major foreshock and the main shock of the earthquake, three hours later. In terms of casualties, earthquakes commonly discriminate against the elderly and women. Age and gender biases need further investigation and should be taken into account in seismic mitigation initiatives.
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Affiliation(s)
- David Alexander
- Institute for Risk and Disaster Management, University College London, London, United Kingdom
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Papadopoulos IN, Kanakaris NK, Danias N, Sabanis D, Konstantudakis G, Christodoulou S, Bassiakos YC, Leukidis C. A structured autopsy-based audit of 370 firearm fatalities: Contribution to inform policy decisions and the probability of the injured arriving alive at a hospital and receiving definitive care. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:667-677. [PMID: 22809705 DOI: 10.1016/j.aap.2012.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 06/16/2012] [Accepted: 06/18/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED The objectives of this autopsy-based audit of firearm-related fatalities were to acquire data to inform policy decisions and to assess the probability of the injured arriving alive at a hospital and receiving definitive care. EVALUATED VARIABLES Demographics; co-morbidities; location and intention of the injury; toxicology; types of firearms; Abbreviated Injury Scale; Injury Severity Score (ISS); transfer means and time; and location of death. RESULTS Of a total of 370 fatalities, 85.7% were male. The median age was 38 (9-95) years. Suicides (47%) and assaults (45.1%) were the most common underlying intentions. The most seriously injured regions were the head (44.5%), thorax (25.7%), abdomen (10.7%), and spine (5.7%). Of the 370 total subjects, 4.9% had an ISS<16 and 59.5% had an ISS≤74; both groups were classified as potentially preventable deaths. The majority (84%) died at the scene, and only 9.8% left the emergency department alive for further treatment. Multivariate analyses documented that postmortem ISS is an independent factor that predicts the probability of the injured reaching a hospital alive and receiving definitive care. Individuals injured in greater Athens and those most seriously injured in the face, abdomen or spine had significantly greater chances of reaching a hospital alive and receiving definitive care, whereas those injured by a shotgun and the positive toxicology group were significantly less likely to. In conclusion, this study provides data to inform policy decisions, calls for a surveillance network and establishes a baseline for estimating the probability regarding the location of firearm-related deaths.
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Affiliation(s)
- Iordanis N Papadopoulos
- National & Kapodistrian University of Athens, University General Hospital Attikon, Fourth Surgery Department, 1 Rimini Street, 124 62 Athens, Greece.
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Xu Y, Huang J, Zhou J, Zeng Y. Patterns of abdominal injury in 37 387 disaster patients from the Wenchuan earthquake. Emerg Med J 2012; 30:538-42. [DOI: 10.1136/emermed-2012-201300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Settervall CHC, Domingues CDA, Sousa RMCD, Nogueira LDS. Preventable trauma deaths. Rev Saude Publica 2012; 46:367-75. [PMID: 22310649 DOI: 10.1590/s0034-89102012005000010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/15/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5%). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7% (SD 11.5%). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.
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Cross-sectional study of craniocerebral trauma in a tertiary hospital after 2008 Sichuan earthquake: a brief report of 242 cases and experiences from West China Hospital. THE JOURNAL OF TRAUMA 2011; 70:E108-12. [PMID: 21248645 DOI: 10.1097/ta.0b013e3181fb4976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aim to analyze clinical features of patients with craniocerebral trauma after 2008 Sichuan earthquake in China. METHODS Medical records of patients with craniocerebral trauma admitted to Department of Neurosurgery in West China Hospital within 30 days after earthquake were retrospectively analyzed. Demographic data, clinical diagnosis, treatment, and prognosis were reviewed. Patients' data from peripheral hospitals were also analyzed. RESULTS Two hundred forty-two patients with craniocerebral injuries were included in the study. The male to female ratio was 1.3:1, and more than half of the patients were between 20 and 60 years. Majority of patients suffered from mild to moderate injuries (88.4%). Scalp wound was the leading type, followed by skull fractures and brain contusion and laceration. Fifty patients (20.7%) underwent craniotomy. Overall mortality was 5.4% (n = 13). In survivors, 186 patients had good outcome (Glasgow Outcome Scale score ≥4, 76.9%). Staphylococcus aureus (n = 74, 44.6%), Aerobacter cloacae (n = 37, 22.3%), and Staphylococcus epidermidis (n = 33, 19.9%) were most frequently isolated bacteria in wound smear. Over 85% (n=6) of patients with infectious wound (n=7) obtained delayed first stage healing. Mortality of patients in local hospitals ranged from 3.8% to 8.9%. CONCLUSIONS Most patients admitted to tertiary hospitals are mildly or moderately injured. Cooperation among different departments is critical to shorten delay in emergency room. First stage wound healing or delayed first stage healing can be achieved in most patients after treatment. More than 76% of seismic injury patients in a tertiary medical center have good outcome.
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Lethal injuries following building collapse: comparison between autopsy and radiographic findings. Radiol Med 2011; 116:969-81. [PMID: 21509558 DOI: 10.1007/s11547-011-0673-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Papadopoulos IN, Kanakaris NK, Bonovas S, Konstantoudakis G, Petropoulou K, Christodoulou S, Kotsilianou O, Leukidis C. Patients with pelvic fractures due to falls: A paradigm that contributed to autopsy-based audit of trauma in Greece. J Trauma Manag Outcomes 2011; 5:2. [PMID: 21214946 PMCID: PMC3024215 DOI: 10.1186/1752-2897-5-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 01/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evaluation of the pelvic fractures (PFx) population in auditing effective components of trauma care is the subject of this study. METHODS A retrospective, case-control, autopsy-based study compared a population with PFx to a control-group using a template with trauma outcome variables, which included demographics, ICD-9, intention, mechanisms, toxicology, Abbreviated Injury Scale (AIS-90), Injury Severity Score (ISS), causes of haemorrhage, comorbidity, survival time, pre-hospital response, in hospital data, location of death, and preventable deaths. RESULTS Of 970 consecutive patients with fatal falls, 209 (21.5%) had PFx and constituted the PFx-group while 761 (78.5%) formed the control-group.Multivariate analysis showed that gender, age, intention, and height of fall were risk factors for PFx. A 300% higher odds of a psychiatric history was found in the PFx-group compared to the control-group (p < 0.001).The median ISS was 50 (17-75) for the PFx-group and 26 (1-75) for the control-group (p < 0.0001). There were no patients with an ISS less than 16 in the PFx group.Associated injuries were significantly more common in the PFx-group than in the control-group. Potentially preventable deaths (ISS < 75) constituted 78% (n = 163) of the PFx-group. The most common AIS3-5 injuries in the potentially preventable subset of patients were the lower extremities in 133 (81.6%), thorax in 130 (79.7%), abdomen/pelvic contents in 99 (60.7%), head in 95 (58.3%) and the spine in 26 (15.9%) patients.A subset of 126 (60.3%) potentially preventable deaths in the PFx-group had at least one AIS-90 code other than the PFx, denoting major haemorrhage. Deaths directly attributed to PFx were limited to 6 (2.9%).The median survival time was 30 minutes for the PFx-group and 20 hours for the control-group (p < 0.001). For a one-group increment in the ISS-groups, the survival rates over the post-traumatic time intervals were reduced by 57% (p < 0.0001).Pre-hospital mortality was significantly higher in the PFx-group i.e. 70.3% of the PFx-group versus 42.7% of the control-group (p < 0.001). CONCLUSIONS The PFx-group shared common causative risk factors, high severity and multiplicity of injuries that define the PFx-group as a paradigm of injury for audit. This reduced sample of autopsies substantially contributed to the audit of functional, infrastructural, management and prevention issues requiring transformation to reduce mortality.
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Affiliation(s)
- Iordanis N Papadopoulos
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Nikolaos K Kanakaris
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Stefanos Bonovas
- Department of Epidemiological Surveillance & Intervention, Center for Diseases Control & Prevention, Athens, Greece
| | - George Konstantoudakis
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Konstantina Petropoulou
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Spyridon Christodoulou
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Olympia Kotsilianou
- National & Kapodistrian University of Athens, Attikon University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Christos Leukidis
- The Athens Forensic Medical Department, Ministry of Justice, 10 Anapaphseos Street, 116 36, Athens, Greece
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Chu ZG, Yang ZG, Dong ZH, Chen TW, Zhu ZY, Shao H. Comparative study of earthquake-related and non-earthquake-related head traumas using multidetector computed tomography. Clinics (Sao Paulo) 2011; 66:1735-42. [PMID: 22012045 PMCID: PMC3180155 DOI: 10.1590/s1807-59322011001000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 06/28/2011] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The features of earthquake-related head injuries may be different from those of injuries obtained in daily life because of differences in circumstances. We aim to compare the features of head traumas caused by the Sichuan earthquake with those of other common head traumas using multidetector computed tomography. METHODS In total, 221 patients with earthquake-related head traumas (the earthquake group) and 221 patients with other common head traumas (the non-earthquake group) were enrolled in our study, and their computed tomographic findings were compared. We focused the differences between fractures and intracranial injuries and the relationships between extracranial and intracranial injuries. RESULTS More earthquake-related cases had only extracranial soft tissue injuries (50.7% vs. 26.2%, RR = 1.9), and fewer cases had intracranial injuries (17.2% vs. 50.7%, RR = 0.3) compared with the non-earthquake group. For patients with fractures and intracranial injuries, there were fewer cases with craniocerebral injuries in the earthquake group (60.6% vs. 77.9%, RR = 0.8), and the earthquake-injured patients had fewer fractures and intracranial injuries overall (1.5 + 0.9 vs. 2.5 +1.8; 1.3 + 0.5 vs. 2.1 + 1.1). Compared with the non-earthquake group, the incidences of soft tissue injuries and cranial fractures combined with intracranial injuries in the earthquake group were significantly lower (9.8% vs. 43.7%, RR = 0.2; 35.1% vs. 82.2%, RR = 0.4). CONCLUSION As depicted with computed tomography, the severity of earthquake-related head traumas in survivors was milder, and isolated extracranial injuries were more common in earthquake-related head traumas than in non-earthquake-related injuries, which may have been the result of different injury causes, mechanisms and settings.
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Affiliation(s)
- Zhi-gang Chu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Chu ZG, Yang ZG, Dong ZH, Chen TW, Zhu ZY, Deng W, Xiao JH. Features of cranio-maxillofacial trauma in the massive Sichuan earthquake: analysis of 221 cases with multi-detector row CT. J Craniomaxillofac Surg 2010; 39:503-8. [PMID: 21112795 DOI: 10.1016/j.jcms.2010.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 10/05/2010] [Accepted: 10/19/2010] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In a massive earthquake, cranio-maxillofacial trauma was common. The present study was to determine the features of cranio-maxillofacial trauma sustained in the massive Sichuan earthquake by multi-detector row computed tomography (MDCT). METHODS The study included 221 consecutive patients (123 males and 98 females; age range, 1-83 years; median age, 35 years) with cranio-maxillofacial trauma in the Sichuan earthquake, who underwent cranio-maxillofacial MDCT scans. The image data were retrospectively reviewed focusing on the injuries of the cranio-maxillofacial soft tissue, facial bones and cranium. RESULTS All patients had soft tissue injuries frequently with foreign bodies. Ninety-seven (43.9%) patients had fractures (1.5 involved sites per patient, range from 1 to 8) including single cranial fractures in 36 (37.1%) cases, single maxillofacial fractures were seen in 48 (49.5%) and cranio-maxillofacial fractures in 13 (13.4%). Single bone fracture was more common than multiple bone fractures (p<0.05). Nasal, ethmoid bones and the orbits were the most commonly involved sites of the craniofacial region. Thirty-eight (17.2%) patients had intracranial injuries, the commonest being subarachnoid haemorrhage and the commonest sites were the temporal and frontal regions. Coexisting intracranial injuries were more common in patients with cranial fractures than in patients with maxillofacial fractures (p<0.05). CONCLUSION Our results indicate that the cranio-maxillofacial trauma arising from the massive Sichuan earthquake had some characteristic features, and a significant number of individuals had the potential for combined cranial and maxillofacial injuries, successful management of which required a multidisciplinary approach.
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Affiliation(s)
- Zhi-gang Chu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, China
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Papadopoulos IN, Bonovas S, Kanakaris NK, Konstantiadou I, Nikolopoulos G, Konstantoudakis G, Leukidis C. Motor vehicle collision fatalities involving alcohol and illicit drugs in Greece: the need for management protocols and a reassessment of surveillance. Addiction 2010; 105:1952-61. [PMID: 20840189 DOI: 10.1111/j.1360-0443.2010.03072.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The frequency and the effect of alcohol and illicit drugs on injury type, severity and location of death in motor vehicle collision (MVC) fatalities were investigated. DESIGN Retrospective case-control study based on autopsy and toxicology. SETTINGS Single faculty accepting referrals from Greater Athens and prefectures. PARTICIPANTS Consecutive pre-hospital and in hospital fatalities. MEASUREMENTS Demographics, toxicology, abbreviated injury scale (AIS), injury severity score (ISS), and location of death. FINDINGS Of the 1860 screened subjects, 612 (32.9%) constituted the positive toxicology group (PTG) for alcohol or illicit drugs or both and the 1248 (67.1%) the negative toxicology group (NTG). The median age was 34 (4-90) years for the PTG and 45 (3-97) years for the NTG. The PTG included significantly higher proportions of males and motorcyclists. The PTG had a 50% increased risk for a severe (AIS ≥3) cervical spine and 85% for a severe upper extremity injury, compared to the NTG. A total of 29.2% of the PTG and 22.4% of the NTG deaths were non-preventable (ISS=75). The frequency of severe trauma (ISS ≥16) was comparable between PTG and NTG (P=0.87). The PTG presented with a median ISS of 43 (6-75) versus 41 (2-75) of the NTG, hence without significant difference (P=0.11). The pre-hospital death rate was 77.8% for the PTG versus 58% of the NTG (P<0.001). The analysis confirmed that the odds of positive toxicology were considerably higher in the subjects who arrived dead at the hospital (OR 2.62, P <0.001). CONCLUSIONS In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.
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Affiliation(s)
- Iordanis N Papadopoulos
- Fourth Surgery Department, University General Hospital Attikon, National and Kapodistrian University of Athens, 1 Rimini Street, Athens, Greece.
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Mateen FJ. Neurological disorders in complex humanitarian emergencies and natural disasters. Ann Neurol 2010; 68:282-94. [PMID: 20818788 DOI: 10.1002/ana.22135] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Complex humanitarian emergencies include the relatively acute, severe, and overwhelming health consequences of armed conflict, food scarcity, mass displacement, and political strife. Neurological manifestations of complex humanitarian emergencies are important and underappreciated consequences of emergencies in populations worldwide. This review critically assesses the existing knowledge of the range of neurological disorders that accompany complex humanitarian emergencies and natural disasters in both the acute phase of crisis and the "long shadow" that follows.
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Affiliation(s)
- Farrah J Mateen
- Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
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Hu J, Guo YQ, Zhang EY, Tan J, Shi YK. Chest injuries associated with earthquakes: an analysis of injuries sustained during the 2008 Wen-Chuan earthquake in China. Surg Today 2010; 40:729-33. [DOI: 10.1007/s00595-009-4130-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/31/2009] [Indexed: 10/19/2022]
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Abstract
Investigating the collapse of a building poses multiple and complex forensic challenges. Large numbers of specialized personnel and equipment are required, as are the combined technical skills of many different kinds of forensic investigators. Forensic pathology teams are integral to these efforts. This report describes the investigation that occurred after a building collapsed in southern Italian location. Several families were still living in small, and abandoned building built in the early 20th century. The buildings were located over cellars 3 meters underground, known locally as "the caves." Eight people were found dead under the debris of one of the collapsed houses and 6 were brought out alive. A team of forensic pathologists and engineers was appointed to investigate the causes of death and of the collapse, respectively. A complete autopsy was performed in every case, along with radiologic assessment and toxicological analysis. Autopsy findings were coded using the Abbreviated Injury Scale and the New Injury Severity Score. Systems for victim identification, arrangements for human remains, management of dead bodies, evaluation of the different patterns of injuries and, finally, detailed identification of the cause of death all played an important role.
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Li GP, You C, Li H, Huang SQ, Yang CH, Xiong H, Zeng YJ, Jia L. The epidemiology and clinical management of craniocerebral injury caused by the Sichuan earthquake. Neurol India 2010; 58:85-9. [DOI: 10.4103/0028-3886.60406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Papadopoulos IN, Papaefthymiou M, Roumeliotis L, Panagopoulos VG, Stefanidou A, Kostaki A. Status and perspectives of hospital mortality in a public urban Hellenic hospital, based on a five-year review. BMC Public Health 2008; 8:28. [PMID: 18215322 PMCID: PMC2257958 DOI: 10.1186/1471-2458-8-28] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 01/23/2008] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Analysis of hospital mortality helps to assess the standards of health-care delivery. METHODS This is a retrospective cohort study evaluating the causes of deaths which occurred during the years 1995-1999 in a single hospital. The causes of death were classified according to the International Statistical Classification of Diseases (ICD-10). RESULTS Of the 149,896 patients who were discharged the 5836 (3.4%) died. Males constituted 55% and females 45%. The median age was 75.1 years (1 day - 100 years). The seven most common ICD-10 chapters IX, II, IV, XI, XX, X, XIV included 92% of the total 5836 deaths. The most common contributors of non-neoplasmatic causes of death were cerebrovascular diseases (I60-I69) at 15.8%, ischemic heart disease (I20-I25) at 10.3%, cardiac failure (I50.0-I50.9) at 7.9%, diseases of the digestive system (K00-K93) at 6.7%, diabetes mellitus (E10-E14) at 6.6%, external causes of morbidity and mortality (V01-Y98) at 6.2%, renal failure (N17-N19) at 4.5%, influenza and pneumonia (J10-J18) at 4.1% and certain infectious and parasitic diseases (A00-B99) at 3.2%, accounting for 65.3% of the total 5836 deaths. Neoplasms (C00-D48) caused 17.7% (n = 1027) of the total 5836 deaths, with leading forms being the malignant neoplasms of bronchus and lung (C34) at 3.5% and the malignant neoplasms of large intestine (C18-21.2) at 1.5%. The highest death rates occurred in the intensive care unit (23.3%), general medicine (10.7%), cardiology (6.5%) and nephrology (5.5%). Key problems related to certification of death were identified. Nearly half of the deaths (49.3%: n = 2879) occurred by the completion of the third day, which indicates the time limits for investigation and treatment. On the other hand, 6% (n = 356) died between the 29th and 262nd days after admission. Inadequacies of the emergency care service, infection control, medical oncology, rehabilitation, chronic and terminal care facilities, as well as lack of regional targets for reducing mortality related to diabetes, recruitment of organ donors, provision for the aging population and lack of prevention programs were substantiated. CONCLUSION Several important issues were raised. Disease specific characteristics, as well as functional and infrastructural inadequacies were identified and provided evidence for defining priorities and strategies for improving the standards of care. Effective transformation can promise better prospects.
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Affiliation(s)
- Iordanis N Papadopoulos
- National University of Athens, 'Attikon' University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Maria Papaefthymiou
- National University of Athens, 'Attikon' University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Leonidas Roumeliotis
- National University of Athens, 'Attikon' University General Hospital, Fourth Surgery Department, 1 Rimini Street, 124 62, Athens, Greece
| | - Vasilios G Panagopoulos
- Department of Medical Informatics, General Hospital of Nikaias Piraeus, 3 Maduvalou Street, 18454 Nikaias, Piraeus, Greece
| | - Anna Stefanidou
- Athens University of Economics and Business, Department of Statistics, 76 Patission Avenue, 104 34 Athens, Greece
| | - Anastasia Kostaki
- Athens University of Economics and Business, Department of Statistics, 76 Patission Avenue, 104 34 Athens, Greece
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Papadopoulos IN. Report of preventable prehospital trauma deaths in a Greek health care region: importance of editorial comments. ACTA ACUST UNITED AC 2007; 62:1316. [PMID: 17495750 DOI: 10.1097/ta.0b013e3180343056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND In December 2003, a devastating earthquake destroyed Bam and surrounding areas in Iran, leaving many people with residual deficits and disabilities, of which approximately 240 patients had spinal cord injury (SCI). METHODS As an independent volunteer working in outpatient clinics, I visited the patients as part of a mobile team and set up a short educational course in spinal cord medicine. RESULTS I visited 34 patients with SCI in the first 3 months. Eight months after the disaster, I visited 54 patients with SCI, 29 female (53.7%) and 25 male (46.3%). Postdisaster problems were identified, including need for accurate data collection, identification of patients' conditions, attention paid to psychosocial issues, ethical dilemmas, and research needs. CONCLUSION Disaster preparedness for earthquakes should include first aid and injury prevention, coordination of relief efforts, basic education and medical care, and short-and long-term rehabilitation needs. The major focus of rehabilitation medicine specialists' should be education of the general and professional population toward integrating the concept of rehabilitation.
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Affiliation(s)
- Gholam Reza Raissi
- Physical Medicine & Rehabilitation Department, Iran University of Medical Sciences, Tehran, Iran.
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