Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review

Morelli, Ivano; Sabbadini, Maria Grazia; Bortolin, Michelangelo

doi:10.1017/s1049023x15004951

Cited by 50 publications

(12 citation statements)

References 27 publications

(83 reference statements)

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“…Although primary data on the anatomic locations of orthopaedic extremity injuries exist for individual major earthquakes, no review has compiled detailed epidemiologic data from these studies. Several reviews have more broadly characterized injury patterns as “lower limb” or “upper limb” and “open” or “closed” [ 5 , 6 ] but do not contain more detailed epidemiologic information.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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BackgroundEarthquakes in developing countries are devastating events. Orthopaedic surgeons play a key role in treating earthquake-related injuries to the extremities. We describe orthopaedic injury epidemiology to help guide response planning for earthquake-related disasters.MethodsSeveral databases were searched for articles reporting primary injury after major earthquakes from 1970 to June 2016. We used the following key words: “earthquake” AND “fracture” AND “injury” AND “orthopedic” AND “treatment” AND “epidemiology.” The initial search returned 528 articles with 253 excluded duplicates. The remaining 275 articles were screened using inclusion criteria, of which the main one was the description of precise anatomic location of fracture. This yielded 17 articles from which we analyzed the ratio of orthopaedic to nonorthopaedic injuries; orthopaedic injury location, type, and frequency; fracture injury characteristics (open vs. closed, single vs. multiple, and simple vs. comminuted); and first-line treatments.ResultsMost injuries requiring treatment after earthquakes (87%) were orthopaedic in nature. Nearly two-thirds of these injuries (65%) were fractures. The most common fracture locations were the tibia/fibula (27%), femur (17%), and foot/ankle (16%). Forty-two percent were multiple fractures, 22% were open, and 16% were comminuted. The most common treatment for orthopaedic injuries in the setting of earthquakes was debridement (33%).ConclusionsOrthopaedic surgeons play a critical role after earthquake disasters in the developing world. A strong understanding of orthopaedic injury epidemiology and treatment is critical to providing effective preparation and assistance in future earthquake disasters.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…However, retrospective event data, particularly in disaster medicine, are the norm. It is suggested that every systematic review faces challenges in terms of the quality of data collected 64 . There was also a geographical and publication bias with 20 of the 60 studies conducted in the US.…”

Section: Limitationsmentioning

confidence: 99%

“…The majority of the data used in this study were retrospective, eventbased data which can be considered to jeopardize the scientific quality and validity of findings. 64 However, retrospective event data, particularly in disaster medicine, are the norm. It is suggested that every systematic review faces challenges in terms of the quality of data collected.…”

Section: Limitationsmentioning

confidence: 99%

“…It is suggested that every systematic review faces challenges in terms of the quality of data collected. 64 There was also a geographical and publication bias with 20 of the 60 studies conducted in the US. This contributes to an acknowledged bias towards US literature as a point of reference in UK health emergency planning and preparedness evidence.…”

Section: Limitationsmentioning

confidence: 99%

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Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review

Razak

Hignett

Barnes

2018

Prehosp. Disaster med.

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IntroductionA Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.ProblemChallenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients.MethodsA systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia).ResultsSixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED.Conclusion:The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures.RazakS, HignettS, BarnesJ. Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review. Prehosp Disaster Med. 2018;33(5):543–549.

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“…shows the 58 articles that were entered into the final SLR study, with 46 single studies, 11 multiple studies, and 21 with control groups. There was 1 study determined to be LOE 18, 29 LOE 2 9-37 , and 28 LOE 3 , with 15 determined to achieve QE 18,11,14,16,18,24,25,31,43,44,46,48,50,55,63,65 , 37 QE 29,10,12,13,15,17,19,21,[26][27][28][29][30][32][33][34][35][36][37][38][39][40][41][42]47,49,51,52,[56][57][58][59][60][61]…”

mentioning

confidence: 99%

The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review

Weinstein

Gosney

Ragazzoni

et al. 2020

Disaster med. public health prep.

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Objective: A systematic literature review (SLR) was performed to elucidate the current triage and treatment of an entrapped or mangled extremity in resource scarce environments (RSEs). Methods: A lead researcher followed the search strategy following inclusion and exclusion criteria. A first reviewer (FR) was randomly assigned sources. One of the 2 lead researchers was the second reviewer (SR). Each determined the level of evidence (LOE) and quality of evidence (QE) from each source. Any differing opinions between the FR and SR were discussed between them, and if differing opinions remained, then a third reviewer (the other lead researcher) discussed the article until a consensus was reached. The final opinion of each article was entered for analysis. Results: Fifty-eight (58) articles were entered into the final study. There was 1 study determined to be LOE 1, 29 LOE 2, and 28 LOE 3, with 15 determined to achieve QE 1, 37 QE 2, and 6 QE 3. Conclusion: This SLR showed that there is a lack of studies producing strong evidence to support the triage and treatment of the mangled extremity in RSE. Therefore, a Delphi process is suggested to adapt and modify current civilian and military triage and treatment guidelines to the RSE.

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Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review

Cited by 50 publications

References 27 publications

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

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

Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review

The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review

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