| Earthquake is caused by the squeeze and collision between the tectonic plates and is one of the worst natural disasters in the world. China is an earthquake prone country. An earthquake measuring 8.0 on the Richter scale occurred at 14:28 pm on May 12,2008 in Wenchuan County, Sichuan province of China (called Wenchuan earthquake or Sichuan earthquake). Wenchuan earthquake is the strongest devastating earthquake since Tangshan earthquake (in 1976) in China and has resulted in 69,227 deaths,374,643 injured and 17,923 missing. The earthquake devastated the medical facilities in the quake zones (including the epicenter and the surrounding areas) and seriously affected the emergency response and treatment capacity of the medical care system, which added difficulties in providing sufficient and timely treatment of a large number of the earthquake trauma patients (only the word "patients" will be used with consideration of abstract length) gathered at very short period of time after earthquake. With aim to provide the patients a better and reasonable treatment, some of the patients admitted to the hospitals or the ambulatorium in the quake zones were managed to be transported to the medical facilities outside Sichuan province according to the deployment the Ministry of Health of China, as is also the ever largest disaster relief operation of the patient transfer after an earthquake.In order to understand the injury and treatment characteristics as well as the treatment outcome of the transferred earthquake patients, accumulate the data of the transferred earthquake trauma patients, summary the experiences and lessons in the medical aid after a major earthquake and provide reference for transfer and treatment of the large casualties in the major disasters in the future, under support by the item "5·12 earthquake trauma data collection and information analysis of consolidation" of the national "863" project, an earthquake trauma database system was developed in this study and the clinical data of the earthquake patients transferred to the hospitals in Chongqing and the military hospitals collected for a preliminary study on the injury profile and treatment of these patients.1 Materials and methods (1) Based on the "Trauma Database System V3.0", the studies of earthquake trauma profile and the demand of the specialist treatments of the earthquake trauma, the survey for collecting earthquake trauma data was developed by using the Delphi method.(2) The earthquake trauma database system V1.0 was aimed to be developed based on the survey form. The database system uses the B/S mode and including the database server, the logic layer and the client (browser) layer. The core development tool was Microsoft's. Net 2.0 version, with C# as development language. The client uses Microsoft's IE browser and the database uses MSSQL2000.(3) As the major research content of the item, we planned to collect the medical records of 3282 earthquake patients transferred to 91 hospitals outside Sichuan province, which was provided by the Ministry of Health and the General Logistics Department of PLA. The method of data collection was to read medical records on site and fill out the survey form. Before data collection, we made a detailed plan and organized training of the data collection personnel.During data collection, the quality control staff was responsible for a strict quality control that was performed simultaneously to inspect the filled survey form and revise then. The quality control staff signed for confirmation after inspection. Finally, we input the collected clinical data into the earthquake trauma database, when a strict quality control process was done likewise. The time spent in inputting the data was similar with that in collection of the medical records.(4) The injury profile and treatment of earthquake trauma patients were analyzed from two aspects:firstly, a preliminary study was carried out on the injury profile and treatment of the transferred earthquake patients so as to provide a general understanding of these patients; Secondly, the injury profile and treatment of the multiple trauma patients were analyzed to discuss the effect of transfer on the treatment outcome of the multiple trauma patients.2 Main results(1) The survey for collecting earthquake trauma data has been developed. The survey involved the information on the patients, the transfer and evacuation, the clinical treatment, the rehabilitation, the outcome and the discharge, etc.(2) The online earthquake trauma database system V1.0 was developed based on the survey form and had been conferred as the national copyright invention patent (No.2010SR035530). There were a total of 728 fields (including the internal fields), of which there were 348 external fields (screen display). The database system had 48 modules and 44 business data tables and other data tables. The main inside information included basic information, injuries, on-site treatment, transfer & evacuation, emergency treatment, hospital treatment, diagnosis, complications, specialist treatment and discharge. The survey could record the information from injury, prehospital and hospital treatment to hospital discharge and integrated with earthquake trauma score and AIS injury assessment information. The database system had the functions including simple custom queries, custom report and custom reports analysis and could meet the requirements of the earthquake trauma support platform and the clinical research on the earthquake injuries.(3) After nearly a year, we have accomplished the complete collection of the clinical data of 3,145 earthquake trauma patients transferred to 92 hospitals in 11 provinces, autonomous regions and municipalities outside Sichuan province, with overall recovery rate of 95.83%, which could satisfy the requirements of analysis on injury and treatment of the transferred earthquake patients. All the collected data of the transferred earthquake patients were input into the "earthquake trauma database system V1.0" to establish an earthquake trauma database.(4) The injury profile and treatment of overall transferred earthquake patients and the multiple trauma patients.1) The general situation of all the transferred patients:The transferred patients were mainly from the hardest-hit zones (70%). The patients were at age of 0-103 years, including the patients at 7-17 years accounting for 17.504% and those at≥61 years for 24.80%. The main occupation of the patients was farmer and student, accounting for 55.71%. The injury cause of crushing accounted for 73.85% of total. The analysis of the patients at different ages showed that the patients at 0-6 years were mainly in rest/sleep/meal or in school; while the patients at age of≥61 years were mainly in rest/sleep/meal at home. The time from injury to admission was at a range of 0-136 days (median value 8).2) Injury profile and treatment of overall transferred patients:①The abbreviated injury score (AIS) was mainly 1-3 points, accounting for 96.83%. The injury sites were mainly the extremities (including lower limbs and upper limbs) and body surface, accounting for 64.27%. The injury sites with≥4 points were mainly the lower limbs, thorax and head, accounting for 11.62%,10.38% and 7.52% respectively. Of all,597 patients (18.98%) had the ISS> 15 points, involving mainly the lower limbs (172 sites,24.75%), thorax (137 sites,19.71%),head (117 sites,16.83%) and the upper limbs (91 sites,13.09%), in consistent with the distribution of the injury sites.②First laboratory examinations showed abnormal results in blood routine examination (1,839 patients,58.47%), in coagulation test results (1,047 patients,52.91%) and in liver and kidney function plus serum electrolytes (810 patients,37.36%), which were improved after treatment, indicating that the patients were under a not bad physical condition after pre-treatment and only needed definitive treatment. The first abnormal myocardial enzymes results in 511 patients (65.60%) suggested possible myocardial injury. Abnormal ECG was found in 1,810 patients (57.55%), mainly manifesting as abnormal tachyarrhythmia, as may be related with stress response caused by earthquake. The operation included mainly the musculoskeletal system surgery, integumentary system surgery and a variety of diagnostic and therapeutic operations. The musculoskeletal system surgery mainly included reduction and fixation for 990 times (93.57%) and next the fracture debridement for 13 times (1.23%). The integumentary system surgery was implemented for 744 times, including debridement for 413 times (55.51%). Type I operative incision resulted in grade C healing in 12 patients (0.98%), with mainly the open fracture reduction and internal fixation of the lower limbs and the removal of the necrotic tissues.④The in-hospital stay of the transferred patients was at a range of 1-422 days, mainly within 100 days (97.93%). The in-hospital stay for≥100 days was found in 65 patients including 21 disabled patients (32.31%). The overall cure rate, disability rate and mortality rate were 90.56%,7.06%and 0.16%respectively.3) Comparative study on the patients transferred to the Grade 3A military hospitals in Chongqing and other places:The patients transferred to Chongqing were set as Group A and those to the places outside Sichuan province and Chonqqing set as Group B. There was no statistical difference in terms of injury severity score in both group (both P> 0.05). The time from injury to transfer was (11.54±11.04) days in Group A and (12.51+3.94) days in Group B, with no statistical difference (P=0.5079). The overall age was distributed mainly at age≥61 years and≤17 years, which accounted for 65.63% of the total. The analysis on the age sections showed that the patients at≥61 years and≤17 years were more than those at the other age sections. The occupation was mainly the farmers and students, which accounted for 30.53% and 27.48% respectively in Group A and for 39.34% and 22.95% in Group B, with no statistical difference between two groups (P=0.2340 for both groups). The infection rate was 22.90% and 9.84% respectively in Groups A and B (P=0.0308), with no death in both groups. The cure rate (P=0.1535) and the disability rate (P=0.1535) showed no statistical difference between two groups, with no infection in both groups. But the function independence measure (FIM) of two groups showed statistical difference (P=0.017).3 Main conclusions(1) The management software of online version earthquake trauma database is developed, with scientific and reasonable structure and function of classification and aggregation, and has obtained copyright protection. The software is currently the first data management software for recording the clinical data of the transferred earthquake patients and provides a good tools for study of information management of the earthquake patients.(2) The database has collected the medical records of 3,145 earthquake patients transferred to the military hospitals and the hospitals in Chongqing, which is the bulk of the data with high integrity and reliability. Data collection is a heavy workload process, with high recovery rate (95.83%). The database with scientific and reasonable structure is developed and provides a reliable data support for research on injury profile of the earthquake patients.(3) The transferred patients are mainly the rural population and the students from the hardest earthquake hit areas. The earthquake occurred at 14:28, when is the class time for the students and the lunch break for the others. The injuries are mainly the crushing injury caused by building collapse, suggesting that the distribution of casualties and the injury sites is closely related with the quality of the buildings. The transfer lasts for a very long time and the peak time appears after the discovery of the dammed lake (73.93%), which is in accordance with the national integrated scheduling.(4) The main injury sites are the extremity (50.89%), chest (11.62%), head (10.38%) and spine (7.52%), suggesting that the wounded should be arranged to orthopedic and surgical departments.(5) Some of the patients have abnormal results on admission and get improved at discharge, suggesting that the transferred patients are in a stable physiological condition on admission and only need further definitive treatment, which may be related with poor medical conditions and austere environment. Better treatment result may be obtained if as early transfer as possible. Myocardial injury should be paid particular attention. High proportion of fracture fixation and surgical debridement in surgical treatment may be correlated with previous unsatisfactory fracture fixation and with the delayed transfer time, as indicates that the comprehensive disaster contingency plan, the transfer mechanism of the wounded and the integrated management system should be established to ensure rapid response when disaster strikes, which have a direct impact on the treatment outcome of the wounded.(6) Part of the transferred patients stayed long in the hospitals, which is correlated with the disability and rehabilitation requirement of the patients.(7) Some of the transferred patients were transferred repeatedly, suggesting that the target department in the hospitals were chosen inappropriately and that the targeted transfer of the special patients should be reasonably arranged in advance.(8) The elderly (≥61 years) and children (≤17 years) have high proportion of multiple trauma, suggesting that this group of persons may suffer severer injuries in the earthquake disaster. The comparative results of the multiple trauma patients showed that the transport distance does not affect the treatment outcome of the multiple trauma patients, suggesting that the emergency medical evacuation is successful in China.(9) The study found that the medical records of some hospitals lacks standardization and completeness and even on-site treatment information, which is not conducive to in-depth study of the earthquake trauma, indicating a necessity in strengthening the standardization in information input and management under leadership by the health authorities so as to create better conditions for research and development of disaster medicine.
|
PDF Full Text Request