Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal

Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaraş earthquake; a section from Gaziantep Nurdağı district

BACKGROUND

An earthquake with a magnitude of 7.7 occurred in Pazarcık District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaraş Earthquake and who were living in Nurdağı District of Gaziantep after the earthquake.

METHODS

Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdağı District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims.

RESULTS

The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05).

CONCLUSION

General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting

BACKGROUND

This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaraş and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach.

METHODS

The study included patients injured in the Kahramanmaraş-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data.

RESULTS

A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support.

CONCLUSION

This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.

Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaraş (Turkey) Earthquake

INTRODUCTION

Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients.

STUDY OBJECTIVE

The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaraş (Turkey) earthquakes.

MATERIALS AND METHODS

This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated.

RESULTS

Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED.

CONCLUSION

Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

First 10 days after the 6th of February 2023 earthquake disaster: experience of an orthopedic clinic on the border of the disaster zone

BACKGROUND

The earthquake disaster that occurred on February 06, 2023, caused serious destruction and loss of life in the south of Türkiye. The purpose of this article consisting of two interconnected parts is to report the experience of our orthopedics clinic, which is located just on the border of the disaster area. The subject of the first part of the study is the characteristics of ortho-pedic traumas in earthquake victims and the treatment methods applied. The subject of the second part is the disaster work plan of the clinic and its consequences in practice.

METHODS

For the first step, descriptive information, diagnoses, and treatment methods of 204 earthquake victims who were treated by our clinic in the first 10 days after the disaster were compiled from the archives. In terms of the second phase of the study, an in-clinic work plan was created on the morning of the 1st day of the disaster. The teams and working hours in the emergency department, inpatient service, and operating room were determined. Hospital management and other clinics were contacted and hospital facilities were organized for orthopedic trauma victims.

RESULTS

The mean age of the patients was 42.3 years. Among the age groups, the smallest group was children under 10 years old (6.4% of all patients). 132 of the patients had at least one fracture in 135 extremities. Most of the injuries involved the lower extrem-ity. 66 patients had crush injury with or without fracture. 181 orthopedic surgical procedures were performed in 144 patients. The most common operations were internal fracture fixation and debridement. The most used implant was the plate-screw combination. Thanks to the in-clinic work plan and the in-hospital assistance and allocation of facilities, we did not experience serious problems in the hospitalization, surgery, and post-operative follow-ups of the patients. Although we received numerous offers of assistance from external institutions, this was not possible due to bureaucratic obstacles. Among our most important problems were the shortage of sterilized powered surgical drills and the lack of a dynamic patient information database.

CONCLUSION

Orthopedic clinics should prepare their in-clinic work plans for earthquake disasters and develop their facilities. In order not to encounter bureaucratic obstacles in emergency assistance, orthopedic clinics in different risk regions should be formally matched beforehand. A patient database table that clinical staff can access and revise using their smartphones facilitates the follow-up of large numbers of simultaneously hospitalized patients.

"Recovering, not recovered" Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal

Background

Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. ‘Resilient hospitals’ have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings.

Objective

This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms.

Methodology

This consists of an in-depth case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data.

Results

Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital’s resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging.

Conclusion

Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience.

Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study

Background

Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic.

Material and methods

Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March–April 2020), non-peak (May–June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay.

Results

5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27–3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0–29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01−6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31–4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27–8.00), medium-volume (OR 2.79, 95% CI 1.14–7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07–4.72).

Conclusion

FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia

PURPOSE

To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

METHODS

A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3.

RESULTS

We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis.

CONCLUSION

It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

Hospital Resilience After the 2015 Earthquake in Nepal: Results From Semi-structured Interviews With Hospital Staff

Background: Resilient hospitals are increasingly recognized as a cornerstone of disaster reduction in global policies such as the Sendai Framework for Action. However, current hospital resilience frameworks emerged from pre-disaster conceptualizations, and have not been verified in real-life disaster contexts nor in the frontlines. Our aim was to study a tertiary hospital's resilience after the 2015 earthquake in Nepal, as experienced by its staff. Methods: We undertook a qualitative study in the Tribhuvan University Teaching Hospital (TUTH), where we conducted 18 semi-structured interviews with hospital staff. We inductively created themes to describe the earthquake burden to the hospital, and to analyze individual resilience of hospital staff. In addition, we deductively documented the resilience of the hospital as a system, according to the system resilience dimensions: means of resilience (redundancy and resourcefulness), and ends of resilience (robustness and rapidity). Results: In terms of robustness, TUTH increased its capacity for earthquake victims as elective activities were temporarily interrupted and quality of care was not a priority. Three stages of rapidity were identified: critical rapidity to address immediate needs, stabilizing rapidity until the hospital re-started routine activities, and recovery rapidity. In addition to the disaster plan, emerging adaptations played a major role in redundancy and resourcefulness. We found that individual resilience depended on three determinants: safety, meaningfulness, and sense of belonging. Conclusions: Hospital resilience results from a complexity of emerging and planned adaptations, as well as from interdependencies with individual resilience. Frameworks and plans to improve hospital resilience must reflect flexibility of response, and a concern for well-being of hospital staff is central for sustainable disaster response and improved resilience.

Challenges in public health and epidemiology research in humanitarian settings: experiences from the field

BACKGROUND

Humanitarian settings often present unique scientific challenges and conditions that distinguish them from standard research settings. While a number of these challenges are faced in both standard settings and humanitarian settings, factors unique to humanitarian settings such as inaccessibility and time sensitivities further exacerbate the effects of these challenges. This analysis focuses on experiences in post-disaster contexts such as Indonesia and India following the 2004 Indian Ocean Tsunami, the Philippines following Typhoon Haiyan in 2013, and Nepal following the 2015 earthquake.

DISCUSSION

Particular issues that we faced in undertaking research in post-disaster settings include challenges with uncharted ethical and cultural considerations, non-standardised administrative methods for record keeping, data sharing and dissemination. While these issues are not unique to post-disaster humanitarian settings, the time-sensitive nature of our work exacerbated the effects of these concerns. Relying on local partners and making quick decisions to tackle issues is imperative for navigating both foreseen and unforeseen challenges. While pre-emptive action to address these concerns is the most efficient means to expedite research protocols, adaptability and contingency planning are key components of practical research implementation in dynamic situations.

CONCLUSIONS

Research is not always a priority in humanitarian settings, so innovative methods are necessary to conduct meaningful and situationally appropriate research in these venues. By understanding available resources, local culture, and political considerations and working efficiently and decisively, we can begin to jump hurdles associated with epidemiologic research in humanitarian settings.

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.

NemaLife chip: a micropillar-based microfluidic culture device optimized for aging studies in crawling C. elegans

In this study, we report a microfluidic device for the whole-life culture of the nematode Caenorhabditis elegans that allows the scoring of animal survival and health measures. This device referred to as the NemaLife chip features: (1) an optimized micropillar arena in which animals can crawl, (2) sieve channels that separate progeny and prevent the loss of adults from the arena during culture maintenance, and (3) ports that allow rapid accessibility for feeding the adult-only population and introducing reagents as needed. The pillar arena geometry was optimized to accommodate the growing body size during culture and emulate the body gait and locomotion of animals reared on agar. Likewise, feeding protocols were optimized to recapitulate longevity outcomes typical of standard plate growth. Key benefits of the NemaLife Chip include eliminating the need to perform repeated manual transfers of adults during survival assays, negating the need for progeny-blocking chemical interventions, and avoiding the swim-induced stress across lifespan in animals reared in liquid. We also show that the culture of animals in pillar-less microfluidic chambers reduces lifespan and introduces physiological stress by increasing the occurrence of age-related vulval integrity disorder. We validated our pillar-based device with longevity analyses of classical aging mutants (daf-2, age-1, eat-2, and daf-16) and animals subjected to RNAi knockdown of age-related genes (age-1 and daf-16). We also showed that healthspan measures such as pharyngeal pumping and tap-induced stimulated reversals can be scored across the lifespan in the NemaLife chip. Overall, the capacity to generate reliable lifespan and physiological data underscores the potential of the NemaLife chip to accelerate healthspan and lifespan investigations in C. elegans.

Changes in patient admissions after the 2015 Earthquake: a tertiary hospital-based study in Kathmandu, Nepal

Literature on earthquake impact on hospital admissions is lacking, particularly in low-resource settings. Our aim was to study the pattern of admissions before and after the 2015 earthquake in a tertiary hospital in Nepal. We used routine hospital data from 9,596 admissions, and defined four periods: pre-earthquake (pre-EQ), acute (EQ1), post-acute (EQ2), and post-earthquake (post-EQ). We compared length of hospital stay (LOS) across the study periods using negative binomial regressions. We used logistic regressions to study changes in probability of admission for diagnostic categories, and Generalized Additive Models to model the difference in number of admissions compared to pre-EQ baseline. LOS was longer in EQ1 than during pre-EQ, in particular for injury-related admissions. In EQ1, the odds of injury admissions increased, while they decreased for the majority of other diagnoses, with the odds of pregnancy-related admissions remaining low until post-EQ. The number of admissions dropped in EQ1 and EQ2, and returned to pre-EQ trends in post-EQ, accumulating 381 admissions lost (CI: 206–556). Our findings suggest that hospital disaster plans must not only foresee injury management after earthquakes, but also ensure accessibility, in particular for pregnant women, and promote a quick return to normality to prevent additional negative health outcomes.

Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study

BACKGROUND

Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI.

METHODS

We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge.

RESULTS

We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%).

CONCLUSIONS

The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.