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

Abstract

Background In 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay. Methods An earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios. Results There were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively). Conclusions Hospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.

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

“…Victims of earthquake-related disasters may present with a wide spectrum of injuries and severities [22][23][24]. In the present study, traumatic injuries were predominant, followed by burns and inhalation injuries.…”

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

“…Shortly after, there is a need for hospital care for trauma-related complications, which could explain why admissions due to factors influencing health status and contact with health services are high in EQ1 and EQ2. A previous study identified this diagnostic category in some of the earthquake victims who were admitted in TUTH 15 . The high probability of admissions in this category in post-EQ may be due to an accumulation of interventions that re-started after weeks of being interrupted, such as the donation of organs and tissues by healthy donors.…”

“…The fact that injury admissions occurring in EQ1 were particularly long may relate to earthquake injury characteristics linked with severity and frequent complications 24 , or because many severe cases were probably referred to TUTH since it is a reference hospital, and it was functional after the earthquake 15 . In addition, external factors may have increased LOS: a disrupted transport network, or destroyed housing, may have delayed patient discharge until an improvement of the situation.…”

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

“…These results support the previous studies on earthquake victims during earthquakes in Iran, China, Pakistan and Nepal whose findings suggest that the majority of survived victims sustained lower limb injuries. 14 , 15 , 16 , 17 , 18 We may presume that the reason for the increased frequency of lower limb injuries during earthquakes is that people during earthquakes rush panicky out of the houses and therefore suffer lower extremity injuries. However, this supposition requires further research to be fully understood.…”