Tropical cyclone Fani-perspective from the trauma and emergency department of an affected tertiary hospital

Our plain-English summary of Tropical cyclone Fani-perspective from the trauma and emergency department of an affected tertiary hospital, by C.R. Mohanty, M. Jain, R.V. Radhakrishnan, et al (Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi, 2020).

The study

• Authors: C.R. Mohanty, M. Jain, R.V. Radhakrishnan, P. Chandra Mohanty, Ritesh Panda
• Journal: Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi
• Published: 2020;23(4):243-248
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.

Methods: A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated.

Results: Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure.

Conclusion: In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.

Copyright © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.

In plain English

This retrospective study described patients brought to the trauma and emergency department of a tertiary hospital in Odisha, India, after tropical cyclone Fani struck on May 3, 2019. It is a study of storm injuries, not of asbestos-related disease. Asbestos appears only as broken sheet pieces thrown by the wind. Of 75 patients, one was brought dead and excluded, leaving 74 (49 male, 25 female; median age 41.0 years). Sharp flying objects were the main cause of injury: 31.2% by broken glass and 20.3% by asbestos, though the article's abstract gives these figures differently. The first patient received was a nine-year-old girl with a head injury from a flying piece of asbestos. Polytrauma (injury severity score above 15) was reported in 67.5% of patients in one place and 66.2% (49 cases) in another. There was no early in-house mortality. The authors described power, oxygen, water and communication failures at the hospital. They noted it was a single-center study that did not survey long-term outcomes.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of hospital disaster records and case sheets, analysed with descriptive statistics
• Who was studied: 74 patients (out of 75 arrivals; one brought dead was excluded) seen at the trauma and emergency department of a tertiary hospital in the cyclone-affected zone of Odisha, India, after cyclone Fani on May 3, 2019
• Exposure: Injuries from tropical cyclone Fani: sharp flying objects (glass pieces and asbestos sheet fragments), falling trees, walls, electric poles and other heavy objects. No asbestos fiber type, dust exposure or asbestos-related disease was studied.
• Main results:
  • Of the 74 included patients, 49 were male (66.2%) and 25 female (33.8%); the median age was 41.0 years (interquartile range 27.7 to 53.0)
  • Sharp flying objects were the dominant cause of injury: 31.2% of patients were injured by broken pieces of glass and 20.3% by asbestos
  • The first patient received during the cyclone was a nine-year-old girl, seen 45 minutes after a head injury from a flying piece of asbestos
  • Median injury severity score was 20 (interquartile range 14 to 28), median revised trauma score 7.841, and median TRISS 97.4 (91.6 to 98.9)
  • Polytrauma (injury severity score above 15) was reported in 67.5% of cases in the results section, and as 49 cases (66.2%) in the discussion. Simple external (soft tissue) injury was the most common injury type.
  • 56 patients (75.7%) were treated at the hospital and 18 (24.2%) were referred to other centers
  • No patient died early in the hospital
  • The hospital itself was damaged: a total electricity blackout, damage to the medical gas pipeline affecting oxygen supply, limited water supply for up to 4 days, and loss of mobile and internet communication
• The authors' conclusion: The authors concluded that tropical cyclones like Fani pose a huge challenge to health care facilities and workers in the affected zone, and that future studies of long-term health consequences are warranted
• Limitations the authors state:
  • Single-center study at one public tertiary hospital; other hospitals in the city also received cyclone patients
  • The actual number of victims may be much higher, and transport problems in the first hours may have reduced the number of patients reaching the hospital
  • Without dedicated disaster surveillance forms, the authors had to rely on the hospital's disaster records
  • Long-term patient outcomes and mental health effects were not surveyed

Related studies

• Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India — P.A.M. Paul, N. Calton, et al. (2021)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand — A. Seeherunwong, N. Chaiear, et al. (2022)
• External validation of prognostic indices for overall survival of malignant pleural mesothelioma — Y. Kataoka, Y. Yamamoto, et al. (2017)
• Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience — P. Loveland, M. Christie, et al. (2018)
• 18F-FDG PET/CT in the management of patients with malignant pleural mesothelioma being considered for multimodality therapy: experience of a tertiary referral center — H.S. Elliott, U. Metser, et al. (2018)

Browse return to medical research.