Hospital Stay As a Proxy Indicator for Severe Injury in Earthquakes: a Retrospective Analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Apr 16

PMID 23585897

Citations 4

Authors

Lu-Ping Zhao

Martin Gerdin

Lina Westman

Jose Manuel Rodriguez-Llanes

Qi Wu

Barbara van den Oever

Liang Pan

Manuel Albela

Gao Chen

De-Sheng Zhang

Debarati Guha-Sapir

Johan von Schreeb

Affiliations

Soon will be listed here.

Abstract

Introduction: Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake.

Methods: A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7<AUC<0.8 was defined as adequate.

Results: Our study shows that LOS discriminatory accuracy is poor for the primary outcome. However, LOS discriminatory accuracy is adequate for resource use, excluding critical orthopaedic interventions and debridement.

Conclusions: Length of hospital stay was not validated as a proxy indicator for severe injury in earthquake survivors. However, LOS was found to be a proxy for major nonorthopaedic surgery and blood transfusion. These findings can be useful for retrospective research on earthquake-injured patients when detailed hospital records are not available.

Citing Articles

"Recovering, not recovered" Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal.

Moitinho de Almeida M Glob Health Action. 2022; 15(1):2013597.

PMID: 35138232 PMC: 8843347. DOI: 10.1080/16549716.2021.2013597.

Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children.

Stewart B, Gyedu A, Goodman S, Boakye G, Scott J, Donkor P Afr J Emerg Med. 2021; 11(1):144-151.

PMID: 33680736 PMC: 7910164. DOI: 10.1016/j.afjem.2020.09.013.

Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal.

Moitinho de Almeida M, van Loenhout J, Singh Thapa S, Kumar K, Schluter B, Singh R PLoS One. 2019; 14(7):e0220016.

PMID: 31318948 PMC: 6638971. DOI: 10.1371/journal.pone.0220016.

Time to include burden of surgical injuries after disasters in the Global Surgery agenda? An assessment of DALYs and averted burden by surgery after the 2008 Wenchuan earthquake.

Rodriguez-Llanes J, Hellman L, Wu Q, van den Oever B, Pan L, Miranda M BMJ Glob Health. 2018; 3(5):e000909.

PMID: 30294459 PMC: 6169667. DOI: 10.1136/bmjgh-2018-000909.

References

Newgard C, Hedges J, Diggs B, Mullins R . Establishing the need for trauma center care: anatomic injury or resource use?. Prehosp Emerg Care. 2008; 12(4):451-8. DOI: 10.1080/10903120802290737. View

Birnbaum M . Account-ability. Prehosp Disaster Med. 2011; 26(2):77-8. DOI: 10.1017/S1049023X11000173. View

Schluter P, Cameron C, Davey T, Civil I, Orchard J, Dansey R . Using Trauma Injury Severity Score (TRISS) variables to predict length of hospital stay following trauma in New Zealand. N Z Med J. 2009; 122(1302):65-78. View

Baxt W, Jones G, Fortlage D . The trauma triage rule: a new, resource-based approach to the prehospital identification of major trauma victims. Ann Emerg Med. 1990; 19(12):1401-6. DOI: 10.1016/s0196-0644(05)82608-3. View

Cumming G, Finch S . Inference by eye: confidence intervals and how to read pictures of data. Am Psychol. 2005; 60(2):170-80. DOI: 10.1037/0003-066X.60.2.170. View

Newgard C, Fleischman R, Choo E, Ma O, Hedges J, McConnell K . Validation of length of hospital stay as a surrogate measure for injury severity and resource use among injury survivors. Acad Emerg Med. 2010; 17(2):142-50. PMC: 4715859. DOI: 10.1111/j.1553-2712.2009.00647.x. View

Malone D, Dunne J, Tracy J, Putnam A, Scalea T, Napolitano L . Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma. 2003; 54(5):898-905; discussion 905-7. DOI: 10.1097/01.TA.0000060261.10597.5C. View

Stephenson S, Henley G, Harrison J, Langley J . Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations. Inj Prev. 2004; 10(6):379-83. PMC: 1730146. DOI: 10.1136/ip.2004.005561. View

Roy N, Shah H, Patel V, Bagalkote H . Surgical and psychosocial outcomes in the rural injured--a follow-up study of the 2001 earthquake victims. Injury. 2005; 36(8):927-34. DOI: 10.1016/j.injury.2005.02.017. View

10.

Fern K, Smith J, Zee B, Lee A, Borschneck D, Pichora D . Trauma patients with multiple extremity injuries: resource utilization and long-term outcome in relation to injury severity scores. J Trauma. 1998; 45(3):489-94. DOI: 10.1097/00005373-199809000-00010. View

11.

Alexander D . The health effects of earthquakes in the mid-1990s. Disasters. 1996; 20(3):231-47. DOI: 10.1111/j.1467-7717.1996.tb01036.x. View

12.

Clarke M . Evidence Aid--from the Asian tsunami to the Wenchuan earthquake. J Evid Based Med. 2011; 1(1):9-11. DOI: 10.1111/j.1756-5391.2008.00007.x. View

13.

Rutledge R, Osler T, Emery S . The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient.... J Trauma. 1998; 44(1):41-9. DOI: 10.1097/00005373-199801000-00003. View

14.

Cryer C, Gulliver P, Langley J, Davie G . Is length of stay in hospital a stable proxy for injury severity?. Inj Prev. 2010; 16(4):254-60. DOI: 10.1136/ip.2009.023903. View

15.

Lett R, Hanley J, Smith J . The comparison of injury severity instrument performance using likelihood ratio and ROC curve analyses. J Trauma. 1995; 38(1):142-8. DOI: 10.1097/00005373-199501000-00032. View

16.

Abolghasemi H, Radfar M, Khatami M, Nia M, Amid A, Briggs S . International medical response to a natural disaster: lessons learned from the Bam earthquake experience. Prehosp Disaster Med. 2006; 21(3):141-7. DOI: 10.1017/s1049023x00003599. View

17.

Redmond A, ODempsey T, Taithe B . Disasters and a register for foreign medical teams. Lancet. 2011; 377(9771):1054-5. DOI: 10.1016/S0140-6736(11)60319-X. View

18.

Diggs B, Mullins R, Hedges J, Arthur M, Newgard C . Proportion of seriously injured patients admitted to hospitals in the US with a high annual injured patient volume: a metric of regionalized trauma care. J Am Coll Surg. 2008; 206(2):212-9. DOI: 10.1016/j.jamcollsurg.2007.08.019. View

19.

Jobe K . Disaster relief in post-earthquake Haiti: unintended consequences of humanitarian volunteerism. Travel Med Infect Dis. 2010; 9(1):1-5. DOI: 10.1016/j.tmaid.2010.10.006. View

20.

Osler T, Rutledge R, Deis J, Bedrick E . ICISS: an international classification of disease-9 based injury severity score. J Trauma. 1996; 41(3):380-6; discussion 386-8. DOI: 10.1097/00005373-199609000-00002. View