A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

Mackenzie, J. S.; Banskota, Bibek; Sirisreetreerux, Norachart; Shafiq, Babar; Hasenboehler, Erik A.

doi:10.1186/s13017-017-0115-8

Cited by 50 publications

(64 citation statements)

References 23 publications

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“…The number of patients reaching hospital is not a complete picture of injuries after an earthquake, since many patients were treated by voluntary health workers locally and were not registered. In a review study on earthquake injuries in developing countries, debridement (33%), closed reduction (24%), open reduction and internal fixation (24%) and external fixation (12%) were described as the most common procedures performed [ 4 ]. In our study, more than 300 patients had orthopaedic procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of earthquakes has been reported to be highest in Asia, with China and Pakistan accounting for 40% of all earthquake-related mortality [ 1 ]. Following earthquakes in low-resource settings, health facilities are often damaged and thus the emergency response capacity is reduced [ 1 , 4 ]. A systematic review of earthquakes in developing countries found that lower extremity fractures were the most common type of injury [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Following earthquakes in low-resource settings, health facilities are often damaged and thus the emergency response capacity is reduced [ 1 , 4 ]. A systematic review of earthquakes in developing countries found that lower extremity fractures were the most common type of injury [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study

et al. 2018

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IntroductionNatural disasters pose a great challenge to the health systems and individual health facilities. In low-resource settings, disaster preparedness systems are often limited and not been well described. Two devastating earthquakes hit Nepal within a 17-days period in 2015. This study aims to describe the burden and distribution of emergency cases to a local hospital.MethodsThis is a prospective observational study of patients presenting to a local hospital for a period of 21 days following the earthquake on April 25, 2015. Demographic and clinical information was prospectively registered for all patients in the systematic emergency registry. Systematic telephone interviews were conducted in a random sample of the patients 90 days after admission to the hospital.ResultsA total of 2,003 emergency patients were registered during the period. The average daily number of emergency patients during the first five days was almost five times higher (n = 150) than the pre-incident daily average (n = 35). The majority of injuries were fractures (58%), 348 (56%) in the lower extremities. A total of 345 surgical procedures were performed and the hospital treated 111 patients with severe injuries related to the earthquake (compartment syndrome, crush injury, and internal injury). Among those with follow-up interviews, over 90% reported that they had been severely affected by the earthquakes; complete house damage, living in temporary shelter, or loss of close family member.ConclusionThe hospital experienced a very high caseload during the first days, and the majority of patients needed orthopaedic services. The proportion of severely injured and in-hospital deaths were relatively low, probably indicating that the most severely injured did not reach the hospital in time. The experiences underline the need for robust and easily available local health services that can respond to disasters.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study

et al. 2018

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“…The population lockdown was announced on the 17th of March 2020 for eight weeks until the 11th of May 2020. The hospital workload from patients in the emergency department (ED) can vary during exceptional events of various natures in Europe (terrorist attacks (1,2)) and the world (natural disasters (3,4)). While there is precedent for large disasters of natural or human origin in recent history, such as pandemics like H1N1 (5), none have been as long-lasting or as global as the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

Crenn

Kinani

Piétu

et al. 2020

Preprint

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Background The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. Methods We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the four-week pre-lockdown period and the eight-week lockdown period divided into two four-week periods: early lockdown and late lockdown. Results There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). Conclusion A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19 second wave lockdown.

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“…It is known that earthquakes cause a sharp increase of medical needs due to injuries, many of them requiring surgical and in-hospital treatment 2,27 . Yet, our final analysis showed that, despite an initial peak of admissions on the fifth day after the earthquake, the total number of admissions dropped in the weeks after the earthquake, and slowly increased back to baseline levels after six weeks.…”

Section: Discussionmentioning

confidence: 99%

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

Almeida

Schlüter

Loenhout

et al. 2020

Sci Rep

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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. Violent, sudden-onset disasters, such as hurricanes or earthquakes, cause considerable damage in communities, leading to widespread destruction 1. While deaths and direct injuries are immediate and expectable consequences of such disasters, drastic changes in the surrounding environment may have longer-term health effects 2-7. These disasters also heavily disturb health systems, which must provide healthcare in a context of sudden increase of health needs, radical change of priority conditions, infrastructural and material damage, and staff shortages 8. While most of the victims in need of care during and after a disaster are managed in an outpatient basis at emergency departments, a considerable amount of people will require hospitalization 9. However, there is inconsistent evidence on the impact on hospital admissions immediately after and in the months following violent, sudden-onset disasters 3,10-12. Earthquakes are the most destructive type of natural disaster, having killed nearly 720,000 people globally between 2000 and 2018. About two thirds of all events worldwide occurred in Asia, where earthquakes affect much more people than earthquakes in all the other continents 13. Rapid population growth, urbanization, poverty, and geological risks contribute to Asia's seismic vulnerability. Nepal is located on the boundaries of two colliding tectonic plates. On April 25 th 2015, an earthquake with a moment magnitude of 7.8 severely hit the country. The epicenter was in Gorkha district, and heavy infrastructural damage occurred in neighbouring regions, including in the capital city of Kathmandu located 76 km away. There were several aftershocks, the strongest occurri...

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A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

Cited by 50 publications

References 23 publications

Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study

Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study

Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

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

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