Abstract
BackgroundIn 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.MethodsAn 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.ResultsThere 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).ConclusionsHospital 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.
Highlights
Earthquakes are large-scale, sudden-onset disasters, which cause widespread damage [1]
We studied the profile of earthquake victims admitted in Tribhuvan University Teaching Hospital (TUTH) and assessed what factors could influence hospital length of stay
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
Summary
Earthquakes are large-scale, sudden-onset disasters, which cause widespread damage [1]. Between 2000 and 2018, there were 520 earthquake events with relevant human impact worldwide, with nearly two thirds having occurred in the Asian continent [2]. Health impacts of earthquakes depend on their magnitude and potential secondary effects, such as tsunamis or landslides [3], and on characteristics of the community: built environment, time to rescue, availability of physicians and hospital beds, and prior training of lay uninjured survivors [3, 4]. Injuries are the most important cause of earthquake-related morbidity, consisting mostly of soft tissue and orthopaedic injuries, fractures. These injuries are more frequent in the extremities, mostly lower limbs, and are prone to wound infections [3]. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay
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