Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study

The injury severity score: an operations perspective

BACKGROUND

The statistical evaluation of aggregation functions for trauma grades, such as the Injury Severity Score (ISS), is largely based on measurements of their Pearson product-moment correlation with mortality. However, correlation analysis makes assumptions about the nature of the involved random variables (cardinality) and their relationship (linearity) that may not be applicable to ordinal scores such as the ISS. Moreover, using correlation as a sole evaluation criterion neglects the dynamic properties of these aggregation functions scores.

METHODS

We analyze the domain and ordinal properties of the ISS comparatively to arbitrary linear and cubic aggregation functions. Moreover, we investigate the axiomatic properties of the ISS as a multicriteria aggregation procedure. Finally, we use a queuing simulation with various empirical distributions of Abbreviated Injury Scale (AIS) grades reported in the literature, to evaluate the queuing performance of the three aggregation functions.

RESULTS

We show that the assumptions required for the computation of Pearson's product-moment correlation coefficients are not applicable to the analysis of the association between the ISS and mortality. We suggest the use of Mutual Information, a information-theoretic statistic that is able to assess general dependence rather than a specialized, linear view based on curve-fitting. Using this metric on the same data set as the seminal study that introduced the ISS, we show that the sum of cubes conveys more information on mortality than the ISS. Moreover, we highlight some unintended, undesirable axiomatic properties of the ISS that can lead to bias in its use as a patient triage criterion. Lastly, our queuing simulation highlights the sensitivity of the queuing performance of different aggregation procedures to the underlying distribution of AIS grades among patients.

CONCLUSIONS

Viewing the ISS, and other possible aggregation functions for multiple AIS scores, as mere operational indicators of the priority of care, rather than cardinal measures of the response of the human body to multiple injuries (as was conjectured in the seminal study introducing the ISS) offers a perspective for their construction and evaluation on more robust grounds than the correlation coefficient. In this regard, Mutual Information appears as a more appropriate measure for the study of the association between injury severity and mortality, and queuing simulations as an actionable way to adapt the choice of an aggregation function to the underlying distribution of AIS scores.

Have There Been any Changes in the Epidemiology and Etiology of Maxillofacial Trauma During the COVID-19 Pandemic? An Italian Multicenter Study

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on people's behavior. The aim of this study has been to evaluate how the SARS-CoV-2 pandemic has impacted the incidence and the features of maxillofacial fractures presented at 6 Italian tertiary centers. Clinical records of all the patients diagnosed for facial fractures between February 23 and May 23, 2019 and 2020 were retrospectively reviewed. Any differences in patient number and characteristics and fracture etiology and site between the 2 groups were then statistically analyzed.

There has been a 69.1% decrease in the number of incoming patients during the pandemic. The number of foreign patients has decreased significantly (23.3% versus 9.6%, P = 0.011) while the average age has increased (38.6 versus 45.6 years old, P = 0.01). Specific statistical significant differences for accidental falls (31.8% versus 50.1%, P = 0.005) and sports injuries (16.9% versus 1.4%, P < 0.001) were found. Concerning fracture sites, significant differences have been found in relation to nasal (22.5% versus 11.4%, P = 0.009) and frontal sinus (0.9% versus 4.4%, P = 0.037) fractures. In conclusion, SARS-CoV-2 pandemic has significantly changed the epidemiology and the etiology of facial traumas.

Which Household Emergency Plans are More Helpful in Tornadoes? Through the Lens of Gerontology

OBJECTIVE

This study investigated how the effectiveness of household emergency plans during tornadoes was associated with family discussions, and the attributes of the plan for different age groups.

METHODS

A telephone survey was conducted in 2014, one year after two 2013 Enhanced Fujita 4/5 tornadoes. The working sample included 223 respondents who reported having a household emergency plan before the tornadoes. The latent class analysis was used to identify the patterns of the plans and develop a typology based on their content. Logistic regression was used to examine predictors for plan effectiveness.

RESULTS

Two classes of plans were identified: quality plans that were rich in content and limited plans that had lower levels of content richness. Older adults were less likely to have quality plans and less likely to have family discussions. Quality of the plan and discussions with family members increased plan effectiveness among older adults, but not younger adults.

CONCLUSIONS

Better emergency planning could be more important for older than for younger adults. The findings were discussed from a gerontological perspective that focuses on older adults' unique needs, vulnerabilities, and resilience factors.

Profile of Chest Injuries and Oxygen Therapy in Trauma Patients with Acute Respiratory Failure after the Jiangsu Tornado in China: A Retrospective Study

BACKGROUND

The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China.

METHODS

The clinical records of 144 patients referred to Yancheng City No.1 People's Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed.

RESULTS

Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%.

CONCLUSIONS

Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.

Factors associated with injuries among tornado victims in Yancheng and Chifeng, China

BACKGROUND

As extremely violent meteorological disasters, tornadoes often cause serious casualties. The study aims to analyze the characteristics and causes of tornado injuries in China under certain humanistic and geographical conditions.

METHODS

A random sampling questionnaire survey was developed and distributed to tornado victims from two separate occurrences: an Enhanced Fujita 4 tornado in Yancheng, and a Fujita 3 tornado in Chifeng. The information of demographic characteristics, disaster environment, and individual behaviors in victims was collected. Chi-square test and binary logistic regression were used to analyze influencing factor of injuries.

RESULTS

A total of 94 valid questionnaires (participation rate 95.9%) were finally collected in Yancheng tornado and 67 valid questionnaires (participation rate 93.1%) in Chifeng tornado. Residents' annual income (OR = 0.10, 95% CI 0.02-0.50, P = 0.005), degree of house collapse (OR = 183.12, 95% CI 8.04-4173.34, P = 0.001) have a significant impact on the probability of injury. Differences in tornado disaster drill awareness (P = 0.009), individual behaviors (P = 0.011) and fear level (P = 0.011) significantly affected the incidence of trauma. Whether victims were indoors or not has no statistical difference on injuries in China.

CONCLUSIONS

Our study clarifies risk factors and is conducive to the expansion of the investigation in tornado casualties. The government should improve the wind-resistance of residential buildings. Victims should participate in disaster prevention drills to take effective disaster avoidance actions.

Injury Patterns and Medical Evacuation of Patients in Chifeng Tornado in China, August 11, 2017

OBJECTIVES

To study injury patterns and medical rescue operations related to tornadoes that occur in rural areas, this study investigated the data pertaining to the 2017 Chifeng tornado (China).

METHODS

Medical records of 52 tornado-related patients were investigated. Data were collected from 3 local hospitals that received all the tornado victims.

RESULTS

A total of 148 injuries were diagnosed. Tornado-related injuries were mainly caused by collapsed houses (51.9%) and direct physical trauma caused by the tornado (38.5%). Most injuries occurred outdoors (63.5%). The head (20.3%) and thorax (14.8%) were most 2 frequent anatomical injury sites. Soft-tissue injuries (43.9%) and contusions and lacerations (37.3%) were the 2 most common injury types. On evaluating the Abbreviated Injury Scale scores, a score of 1 was the most common (66.2%), and a score of 6 was not recorded.

CONCLUSIONS

A trailing phenomenon in the distribution of time to admission among the victims of a particular tornado in China was observed. The delivery is timely compared with nondisaster situation. There was a statistically significant difference of injury causes between outdoor and indoor patients. Helmets should be used by potential tornado victims. Basement units capable of functioning as shelters should be built in villages.