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Risk Factors Of Occurrence And Severity Of Crush Syndrome In Pediatrictrauma Victims Of China Wenchuan Earthquake

Posted on:2011-10-10Degree:MasterType:Thesis
Country:ChinaCandidate:Y L FuFull Text:PDF
GTID:2154360308984913Subject:Emergency Medicine
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Background : The Wenchuan earthquake happened in SiChuan Province of China at 2:28 P.M. on May 12, 2008. The quake had a magnitude of 8.0 on the Richter scale. Direct trauma was the main cause of death during the earthquake, while the main causes of death after the earthquake were crush syndrome and its complications, such as renal failure (RF), hypovolemic shock, hyperkalaemia, sepsis,acute respiratory distress syndrome (ARDS), and so on. Although many reports have been made about crush injury (CI) and CS, few reports have examined CI and CS in children. Ninety-eight pediatric trauma victims were transferred to our hospital after the Wenchuan earthquake from May 13, 2008 to June 12, 2008. we analyzed the factors affecting the occurrence and severity of CS after CI in pediatric trauma victims Wenchuan earthquake.Objective: We undertook an analysis of the factors affecting the occurrence and severity of crush syndrome after crush injury in pediatric trauma victims of the Wenchuan earthquake which hit the SiChuan Wenchuan area of China at 2:28 P.M. on May 12, 2008. Methods: A retrospective review of the medical records of 98 patients who were transferred to our hospital was performed. We collected data on risk factors such as age, gender, time under ruins, injury type, amputation, wound infection, renal replacement therapy(RRT), and other factors, which were assessed with statistical tests including Student's t-test,χ2, Fisher's exact tests, and logistic regression analysis for the occurrence of crush syndrome after crush injury. Possible risk factors impacting on CS severity were analyzed.Results:1.Descriptive data:Of the 98 patients, 44 were male and 54 were female.The patients ages ranged from 8 to 211 months. Time under ruins ranged from 0.5 hour to 50 hours. Of chest and abdominal part CI (18 cases ), and other trauma (21 cases), there were no cases that developed CS. Of the extremity CI victims(59 cases ), 15 developed CS. The incidence of CS after earthquake reached 15.3% (15/98). While the incidence of CS reached 25.4% (15/59) after extremity CI. 6 cases had RRT, and the RRT proportion reached to 40% (6/15). All the patients recovered kidney function and none deaths. Among 98 cases in our study, only eight patients required amputation because of necrosis, thanatosis and nonfunction of extremities in the field, not of the CS threat to life. Time of amputation after rescued ranged from 10 hours to 100 hours,average:44.750±3.381 hours. 2.Factors influencing the occurrence of CS: The differences between age, time under ruins, amputation, and closed-crush injury were striking between the simple crush injury (CI) group and crush syndrome (CS) group. When the data was further analyzed with binary logistic regression, we discovered that age, time under ruins and closed-crush injury were statistically significant for the development of CS in children. The log-odds ratio (log-OR) for these three factors were respectively 1.046, 1.220, and 0.062 (all P<0.05). Gender (P=0.557), upper or lower limbs injury (P=0.941), wound infection (P=0.297) , and amputation(P=0.296), were not statistically significant.3.Factors influencing severity of CS: Univariate analysis between the RRT group and non-RRT group found that wound infection, independent of other factors such as age, gender, time under ruins, injury type, or amputation, had a statisticaly significant association with the severity of CS (P=0.041). There were 74 cases of complicating wounds in 98 injured children, composed of 47 cases with open injuries, 13 cases with CS fasciotomy, and 14 cases with other incisional wounds. Complicating wound infection (raw surfaces, when cultured, had pathogenic bacterial growth) was seen in 31 cases. The difference in wound infection rate between patients with open injury and CS fasciotomy incision was not significant (P=0.754), but there was a significant difference between those patients with CS fasciotomy incision and those with other operative incisions (P<0.05).Conclusion: The occurrence of crush syndrome chiefly derives from extreme crush injury, and also has a significant association with age, time under ruins, and closed crush injury in children, but gender, upper or lower limbs injury, wound infection, and amputation, were not. Infection of incisional wounds after CS fasciotomy is a risk factor for aggravation of CS.
Keywords/Search Tags:Crush syndrome, Earthquake, Risk factors
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