Risk factors of earthquake inpatient death: a case control study
Tóm tắt
At 2:28 p.m. on 12 May, 2008, a devastating earthquake measuring 8.0 on the Richter scale hit Wenchuan County, Sichuan Province in southwest China, and resulted in the deaths of thousands of people. To date, few epidemiological studies have been conducted on the determinants of the mortality of patients hospitalised after an earthquake. This paper is aimed at identifying the contributing factors of mortality and providing a clinical reference for the management of those injured in earthquakes. A hospital-based case-control study was conducted. Cases included all deaths (n = 36) due to earthquake injuries in the West China Hospital. Controls were the quake survivors from the same hospital by at a ratio of four survivors to one death matched for sex and age. Data sources included death certificates and medical records. A conditional logistic regression was performed to assess the odds ratio (OR) of variables used in the study. A chi-squared test for trend was performed to reveal the possible relations between risk factor (variable) number and case fatality. People with a severe traumatic brain injury (TBI) had the greatest risk of death (adjusted OR = 253.3, 95% confidence interval (CI) = 8.9 to 7208.6), followed by patients with multiple system organ failure (MSOF; adjusted OR = 87.8, 95% CI = 3.9 to 1928.3). Prior major disease and infection significantly increased the risk of earthquake-related death (adjusted OR = 14.9, 95% CI = 1.9 to 119.0; adjusted OR = 13.7, 95% CI = 1.8 to 103.7; respectively). The number of fatal cases increased as the risk factor numbers also increased. Severe TBI, infection, MSOF and prior major disease are the significant determinants of earthquake-related inpatient death in the 2008 Wenchuan earthquake. Future research with a large sample size including macro- and micro-level factors is needed.
Tài liệu tham khảo
Juan Xie, Liang Du, Tian Xia, Miye Wang, Xiang Diao, Li Y: Analysis of 1856 inpatients and five deaths in the West China Hospital of Sichuan University from the Wenchuan earthquake. J Evid Based Med 2008, 1: 20-26. 10.1111/j.1756-5391.2008.00010.x
Chou YJ, Huang N, Lee CH, Tsai SL, Chen LS, Chang HJ: Who is at risk of death in an earthquake? Am J Epidemiol 2004, 160: 688-695. 10.1093/aje/kwh270
Osaki Y, Minowa M: Factors associated with earthquake deaths in the great Hanshin-Awaji earthquake, 1995. Am J Epidemiol 2001, 153: 153-156. 10.1093/aje/153.2.153
Peek-Asa C, Ramirez M, Seligson H, Shoaf K: Seismic, structural, and individual factors associated with earthquake related injury. Inj Prev 2003, 9: 62-66. 10.1136/ip.9.1.62
Duman H, Kulahci Y, Sengezer M: Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J 2003, 20: 251-252. 10.1136/emj.20.3.251
Maas AI, Stocchetti N, Bullock R: Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008, 7: 728-741. 10.1016/S1474-4422(08)70164-9
Valadka A: Injury to the cranium. In Trauma. Edited by: Moore E, Feliciano D, Mattox K. New York: McGraw-Hill; 2004:385-406.
Bywaters EG, Beall D: Crush injuries with impairment of renal function. 1941. J Am Soc Nephrol 1998, 9: 322-332.
Bellomo R, Kellum J, Ronco C: Acute renal failure: time for consensus. Intensive Care Med 2001, 27: 1685-1688. 10.1007/s00134-001-1120-6
Armenian HK, Melkonian A, Noji EK, Hovanesian AP: Deaths and injuries due to the earthquake in Armenia: a cohort approach. Int J Epidemiol 1997, 26: 806-813. 10.1093/ije/26.4.806
Chan CC, Lin YP, Chen HH, Chang TY, Cheng TJ, Chen LS: A population-based study on the immediate and prolonged effects of the 1999 Taiwan earthquake on mortality. Ann Epidemiol 2003, 13: 502-508. 10.1016/S1047-2797(03)00040-1
Mahue-Giangreco M, Mack W, Seligson H, Bourque LB: Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake, Los Angeles, California. Ann Epidemiol 2001, 11: 347-357. 10.1016/S1047-2797(01)00220-4
Tanaka H, Oda J, Iwai A, Kuwagata Y, Matsuoka T, Takaoka M, Kishi M, Morimoto F, Ishikawa K, Mizushima Y, Nakata Y, Yamamura H, Hiraide A, Shimazu T, Yoshioka T: Morbidity and mortality of hospitalized patients after the 1995 Hanshin-Awaji earthquake. Am J Emerg Med 1999, 17: 186-191. 10.1016/S0735-6757(99)90059-1
Bouras T, Stranjalis G, Korfias S, Andrianakis I, Pitaridis M, Sakas DE: Head injury mortality in a geriatric population: differentiating an "edge" age group with better potential for benefit than older poor-prognosis patients. J Neurotrauma 2007, 24: 1355-1361. 10.1089/neu.2005.370
Oncül O, Keskin O, Acar HV, Küçükardali Y, Evrenkaya R, Atasoyu EM, Top C, Nalbant S, Ozkan S, Emekdaş G, Cavuşlu S, Us MH, Pahsa A, Gökben M: Hospital-acquired infections following the 1999 Marmara earthquake. J Hosp Infect 2002, 51: 47-51. 10.1053/jhin.2002.1205
Bulut M, Fedakar R, Akkose S, Akgoz S, Ozguc H, Tokyay R: Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emerg Med J 2005, 22: 494-498. 10.1136/emj.2004.016295
Fry DE, Pearlstein L, Fulton RL, PH Jr: Multiple system organ failure. The role of uncontrolled infection. Arch Surg 1980, 115: 136-140.