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Earthquake-related injuries and population rates of injury. Fatal and hospital-admitted injuries. Northridge earthquake, 1994
Source publication
The Northridge earthquake struck Los Angeles on 17 January 1994, originating from a previously unknown thrust fault. The earthquake measured 6.7 on the Richter scale and caused extensive damage to buildings, utilities and roadways. This report describes injuries occurring in the Northridge earthquake which resulted in death or hospital admission.
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Contexts in source publication
Context 1
... hospitalized injury rate of 1.56 per 100 000 residents was 4.1 times the fatality rate of 0.37 per 100 000 residents (95% confidence interval [CI] : 2.81-5.99) ( Table 1). ...
Citations
... In addition, the thoracic and spinal injury rates of the patients are compatible with the literature. 4,16,17 Extremity trauma and crush syndrome are among the most common complications among earthquake survivors. These conditions require close follow-up in terms of the need for fasciotomy and amputation, as well as acute kidney injury and the need for urgent dialysis, and infections that may cause sepsis. ...
Objective
This study focuses on adults affected by the February 2023 Turkey earthquakes, aiming to uncover demographic and clinical traits.
Methods
A retrospective analysis of data from adult patients who sought emergency care between February 6 and February 21, 2023, following the earthquakes, was conducted.
Results
Among 3072 patients, 1544 (50.3%) of whom were women, trauma (31.1%) was the most prevalent cause of emergency department presentations. The median age of all patients was 44 y (interquartile range [IQR] 31-61 y). Hatay province accounted for 65.2% of trauma patients as origin. Most of the patients (66.8%) presented to the emergency department by their own means, while this was opposite for trauma patients, of whom 54.5% was transferred by means of Ambulance Service. Half of the total trauma patients were rescued from the debris, and 75.9% sustained limb injuries. Crush syndrome affected 24.7%, and emergency hemodialysis was performed on 9.1%, whereas emergency surgery was performed on 22.8% of all trauma cases. Overall, 10.2% of trauma patients lacked any identification. The rate of emergency department admittions due to respiratory and cardiovascular diseases was higher at the time of the earthquake compared with the previous year ( P < 0.001).
Conclusions
The insights gained from this study hold valuable implications for disaster response strategies, emphasizing the importance of preparedness, timely intervention, and comprehensive patient care.
... In earthquakes, most hospital admissions happen within the first 3 days after the event. 22 Compatible with this conjecture, only 2.4% of the 902 patients were admitted 7 days or more after the Armenian earthquake. 23 In the Marmara earthquake study, a similar result was observed: earthquake patients were admitted the most 3-7 days after the earthquake. ...
... When the top three authors are examined, Yanai shares the ranking with 6 publications, Ueda 6 publications, and Kobayashi 5 publications (Table 1). (14)(15)(16)(17)(18). The focus of RQ3 is to analyze the performance of academic publications dealing with ERLD, using the most influential publications as indicators. ...
... Most deaths were reported from building collapses, and most hospital-accepted injuries were caused by falling or being struck by objects. While extremity injuries were the most common among hospital admissions, head, and chest injuries were the most common injuries leading to death (15). Their study of Phalkey et al., which investigated the epidemiology of injury after the 2001 Gujarat earthquake in India, found that younger men were more prone to injury, unlike the study of Peek-Asa et al. (18). ...
Aim: Earthquake-related lung diseases (ERLD) can be seen as direct and indirect disaster results. ERLD such as inhalation of dust and particulates from collapsed buildings in earthquakes, aspiration of water and pathogens due to tsunami after earthquakes, pulmonary thromboembolism, infectious respiratory diseases, and chest traumas can develop after earthquakes. The aim of this bibliometric review is to explore the intellectual structure of ERLD publications. Material and Methods: A search strategy for databases related to the ERDL area was developed. 334 articles were accessed in the Web of Science database. As a result of the full-text readings, 152 articles remained, and 152 articles were subjected to citation and co-citation analysis with bibliometric software. In addition to this research, methodologies based on cluster analysis were used to examine the intellectual structure of the field. Results: When the time period of the publications is examined, it is seen that the first publication was published in 1996. When the top three authors are examined, Yanai shares the ranking with 6 publications, Ueda 6 publications, and Kobayashi 5 publications. Japan, also an earthquake country, is in first place with 50 publications. Three main clusters were identified. These clusters are “chest traumas: types, frequency, and medical intervention strategies," “earthquake preparedness and earthquake response capacity," and "respiratory tract infections and an earthquake." Conclusion: In addition to identifying the most influential journals, authors, and countries on earthquakes in the area of ERLD, this research identified the dominant research themes in this field. Our research outlines the area of ERLD, provides an agenda for future research, and contributes to the fact that the relationship between earthquakes and pulmonary diseases is studied more deeply.
... However, in addition to the blocked roads caused by collapsed building, the destruction of nonstructural elements is also prominent. Previous seismic damage investigations have demonstrated that large quantities of casualties are caused by the falling of nonstructural elements, such as partition walls (Peek-Asa et al. 1998;Chan et al. 2006;Qiu et al. 2010). Falling nonstructural components can cover evacuation roads and obstruct the postdisaster evacuation (Goretti and Sarli 2006;Hirokawa and Osaragi 2016). ...
The reasonable spatial allocation of shelters in key urban areas and the improvement of the evacuation efficiency are critical agendas in the field of earthquake mitigation and resilient cities. Based on the conventional shelter location model, which ignores blocked roads and has deficiencies on the computational accuracy of evacuation demands and evacuation environment, this study proposes an advanced methodology for the spatial allocation of shelters considering the blockage effect on roads under earthquakes. First, based on the elastic-plastic analysis of building groups, the damage condition of each building under different seismic intensities and the influence range of falling components on evacuation roads are determined. Second, the evacuation demands are identified with an accuracy at the building scale. Third, this study proposed the hybrid cellular automata evacuation model, which combines the merits of the microscopic evacuation and macroscopic evacuation models. The proposed model not only reflects the evacuation behavior of refugees and but also has acceptable computational efficiency. Fourth, the shelter quantity is taken as the optimization objective to complete the spatial allocation of shelters via a cyclic verification and simulations for regional evacuations. Finally, Yangbi City, Yunan Province, China is employed as a case study to prove the effectiveness of the proposed method.
... It was mentioned that injury rates were equal in terms of gender but increased significantly with increasing age. 12,13 In a study conducted after the 1994 Los Angeles earthquake, it was emphasized that the risk of injury was higher in individuals over 65 years of age compared to younger people and in women compared to men. 14 In our series, the number of male patients was moderately higher. The number of young adult patients aged 20-60 years is 68%. ...
Objective
This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center.
Methods
Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded.
Results
The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department.
Conclusion
This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.
Level of Evidence
Level IV, Diagnostic Study.
... [3,4] The rate of detecting spinal injuries in trauma patients related to earthquakes ranges from 13% to 15.2%, while the frequency of spi-OR IGINAL ARTICLE nal injuries among all trauma patients is between 1.6% and 10%. [5][6][7] The region most commonly affected by spinal injuries caused by earthquakes is the thoracolumbar junction . [8] This transitional area between the less mobile thoracic spine and the more mobile lumbar vertebrae is inherently more vulnerable to injury. ...
Background:
Earthquakes are devastating events that may severely injure the human body. The spine is one of the important parts of the human body that may be affected by earthquake trauma. The aim of this study is to focus on thoracolumbar fractures secondary to the 2023 Turkey Earthquake.
Methods:
The data of 15 patients who were affected by the earthquake, rescued from the rubble, and subsequently treated for spinal fractures in our department were reviewed retrospectively. The clinical, radiological, and surgical features of the patients were recorded, and the outcomes were investigated.
Results:
Among the 15 patients, 12 were female, and 3 were male. Their ages ranged from 22 to 79 years. The average duration of being trapped under debris was 4.7 hours. According to the Frankel classification, 12 patients (80%) were categorized as Frankel E, 2 patients (13.3%) as Frankel A, and 1 patient (6.6%) as Frankel C. Of these patients, 6 underwent surgical treatment, while a total of 9 patients received conservative treatment. Multiple vertebral fractures were identified in 4 patients. While 3 patients with multiple fractures were treated conservatively, 1 patient underwent surgery due to an L1 fracture. All surgeries consisted of spinal canal de-compression and spinal instrumentation. Among patients without thoracolumbar junction fractures, 1 had a T8 fracture, 1 had an L4 fracture, and 1 had a sacral fracture along with an accompanying lumbar plexus injury.
Conclusion:
Thoracolumbar fractures are frequently observed after earthquakes. However, the exact mechanism of these fractures is not well known. Surgical management should be reserved for patients with progressive neurological deficits, while conservative treatment is the option for stable fractures.
... This is likely due to the prolonged and excessive pressure required to induce such a syndrome, frequently culminating in fatal outcomes. 23,24 This study, encompassing a cohort of patients, revealed no significant disparities in terms of extremity, vertebral, cranial, or abdominal injuries between individuals necessitating dialysis and those who did not. However, it is important to highlight that thoracic injuries exhibited a discernible disparity; nonetheless, it is noteworthy that this specific injury did not robustly predict the need for dialysis, in line with the existing body of literature. ...
Objectives
Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis.
Methods
A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis.
Results
The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%.
Conclusions
The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.
... Long bone fractures, soft-tissue damages, and crush injuries are among the most common earthquake injuries. [3,4] The documentation of epidemiological information and management experience regarding these earthquake injuries are critical for creating plans for future similar disasters. [5,6] In this two-part study, as a university clinic of orthopedics located on the edge of the disaster zone, we share our experience of the first 10 days after the earthquake. ...
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.
... Earthquakes are devastating natural disasters that have caused the loss of more than a million lives over the past few decades [8][9][10][11] . Peripheral nerve injuries are one of the important causes of morbidity induced by compression for a long time after an earthquake. ...
Background Earthquakes are one of the most common causes of mortality and morbidity due to natural disasters. In particular, soft tissue and musculoskeletal injuries are the most common types of injuries following earthquakes and the most common reason for hospital admission. Turkey is a region with a very high risk of earthquakes. Compression is one of the most common causes of mechanically induced peripheral nerve injuries. Peripheral nerve injuries cause long-term disruptions in daily life, professional development, and education. These injuries are the important causes of labor loss, especially in young adult patients. The purpose of our study is to emphasize the importance of early diagnosis and treatment for these injuries by sharing our observations on compressive peripheral nerve injuries seen in earthquake victims after the Kahramanmaraş earthquakes on February 6. Materials and Methods We included patients with peripheral nerve injury who were admitted to the physical therapy clinic of Adana City Hospital for three months starting from February 6, 2023. Results The mean age of the injured was 32.64±17.63 years. The median time of being pulled from the rubble was 24 hours. 95.5% were living in Hatay province. The most common sites of peripheral nerve injury were legs (43.3%), arms (17.9%) and forearms (16.4%). 31.3% of the injured had bone fractures. The most common complaints were weakness in the legs (31.3%), foot drops (29.9%), and wrist drops (20.9%). Conclusion Earthquake is a natural disaster that can cause blunt and penetrating injuries and serious peripheral nerve injuries. Thus, it should be kept in mind that these injuries, which significantly affect the quality of life, are quite common and may be overlooked during the acute phase after earthquakes.
... Many studies have shown that more than half of the injuries after earthquakes are caused by extremity fractures. [2][3][4][5][6] Earthquake-related injuries are typically caused by falling objects or tissue compression over a prolonged period. [7] This highlights the importance of multidisciplinary management by orthopedic and trauma physicians. ...
... [7] This highlights the importance of multidisciplinary management by orthopedic and trauma physicians. [5,6,[8][9][10] On February 6 th , 2023, two major earthquakes with magnitudes of 7.7 and 7.6 struck the districts of Pazarcık and Elbistan in Kahramanmaras, affecting a total of 11 provinces and 110,000 square kilometers with a 350-km long. [11] These earthquakes resulted in at least 50,500 deaths and more than 120,000 injuries. ...
... [3] Many studies have reported that the rate of hospital admission in the immediate aftermath of an earthquake is the highest within the first 24 h, making it crucial to prepare and equip medical facilities rapidly. [4][5][6][7] In our study, the first peak of patient admissions (42.0%) occurred within the initial 24 h of the earthquake. ...
Objectives:
The aim of this study was to evaluate musculoskeletal injuries, clinical follow-ups and treatments of trauma patients admitted to our hospital after the 2023 Kahramanmaras earthquake.
Patients and methods:
Between February 6th, 2023 and February 16th, 2023, a total of 957 trauma patients (452 males, 505 females; mean age: 36.2±19.9 years; range, 0 to 97 years) who were affected by the earthquake were retrospectively analyzed. Age, sex, presence of orthopedic consultation, diagnosis of open/closed fracture, diagnosis of dislocation, presence and classification of soft tissue injury, additional system injury, preoperative and postoperative neurovascular examination status, presence of compartment syndrome, conservative/surgical applications, operation side, fasciotomy surgery and level, amputation surgery and level, length of stay in the hospital and intensive care unit (ICU), the Mangled Extremity Severity Score (MESS) score were collected.
Results:
A total of 811 of the survivors were Turkish and 146 were Syrians. Of 957 earthquake victims, 40% had soft tissue injuries, 19% had closed fractures, 8.9% had other system injuries, 7.7% had crush injuries, 4.1% had nerve injuries, 2.1% had compartment syndrome, 2.1% had vascular injury, 1.8% had dislocation, and 1.7% had open fracture. Surgical or conservative treatments were applied to 574 patients with musculoskeletal injuries. Conservative treatment was applied to 322 of 574 patients and surgical procedure was applied to 252 patients.
Conclusion:
The highest patient density is experienced within the first 24 h after a devastating earthquake. The most common injuries due to high-energy trauma are isolated soft tissue injuries and fractures. The definition of the demographic characteristics and clinical outcomes of earthquake patients is critical to the development of preparedness, response, and recovery policies for future disasters..
