Meta-analysis Of Epidemiology And Clinical Characteristics Of Head Injuries In The Wenchuan Earthquake

Objective:To estimate the epidemiology and clinical characteristics of patients with head injuries in Wenchuan earthquake. The relevant issues of earthquake related head injury (ERHI), such as injury mechanism, risk factors, clinical features, treatment strategies were investigated as to analyze the characteristics. challenges and effective preventive measures of the emergency management of ERHI. The comprehensive study of the overall situations of the Wenchuan earthquake disasters related head injury provided the basic data for the formulate scientific, rational and standardized clinical rescue strategies of ERHI and the effective interventions for sudden major catastrophic events.Methods:With the keywords of "earthquake, head injury, craniocerebral injury, brain injury, craniocerebral trauma, epidemiology, diagnosis and treatment" a comprehensive study of clinical data and literature meta-analysis evaluation of the2008-2011published Chinese and English articles on the traumatic brain injuries caused by the Wenchuan earthquake were carried out.Results:Totally68retrieved documents met the essential requirements. The clinical data of GCS, types of head injuries, combined injuries and GOS were reported in some degree. According to the literature inclusion criteria, there were18articles were enrolled into the standard meta-analysis. They were sampled from all the3involved provinces as Sichuan, Shanxi and Gansu. And this covered the26earthquake hit and severe hit regions. As the cumulative statistics showed that the earthquake injured32415people, in which5559people had head injuries (17.1%). The Male:female ratio was1.53:1. The mild earthquake caused head injuries accounted for69.4%, moderate21.0%, and severe9.6%. The open head injuries accounted for17.7%and combined injuries accounted for54.7%. The mortality rate of earthquake caused head injury was0.16%. The gender composition, stratified by age and injuries of ERHI are statistically significant different from the common traumatic brain injury (P<0.01).Conclusion:Head injuries caused by the Wenchuan earthquake had the characteristics of the high morbility, the complicated injury mechanism, the high rate of combined injuries and multi-organ dysfunctions, rapid clinical changing, difficulty in rescue, high disability and mortality. The Wenchuan earthquake belongs to inland mountain area earthquake. The mechanical blunt injury was the major injury mechanism. The building collapse was the main cause of injuries. The complicated injuries and the combined injuries in different organs were very common. The elder, women and children were the high risk population of earthquake. And to improve the emergency response to victims of disaster in different stages’ hospitals would play greatly important role in increasing the rescue survival and reducing the disability and mortality.Infection incidence of ERHI was increased compared with the general brain injuries. Post traumatic epilepsy after earthquake (PTEAE) was a serious complication of the survivors of earthquake traumatic brain injury. Which can occur within a long latency after ERHI. Long-term monitoring, precaution against, and regular treatment of late PTEAE are very important. The proportion of moderate and severe ERHI in-patients was much less than estimated. How to manage the severe ERHIs effectively within the first72hours after earthquake, the golden period for rescue, needs further study and improvement. The scientific, rational, fast and efficient ERHI first aid and subsequent treatment included pre-judgment and fast classification of the site injury, the maintenance of vital signs and quick, effective control of the deterioration of injuries, emergent surgical treatment and efficient mechanism for the evacuation and transportation, comprehensive multidisciplinary sequential treatment of combined injuries, the prevention and management of complications, rehabilitation of treatment and psychological consult.To strengthen the earthquake monitoring and forecasting, improve the legal management of the prevention and reduction of earthquake disaster, carry out rational and in timely manner rescue based on the objective geographical and timing situations in different types of earthquake disasters, may increase the predictability of the wounded, and enhance rescue controllability. The essential role of first-line hospital in the disaster areas in ERHI rescue should be well-emphasized. The serious wounded victims evacuated and transferred after the initial rescue or emergency management could maximize the success rate of ERHI rescue. To establish a special collaborative network platform among different medical institutions, should benefit for the research and management of the earthquake caused brain injuries.Up to date, there is no epidemiological investigation and bulk cases analysis report of the ERHIs. Many events as the post-earthquake paralysis of the medical institutions and medical facilities, lost of contact in the process of patients transportation to second-line hospitals and many other large medical institutions all over the country, the changing of address and means of communication after earthquake or return home from rehabilitation outside, lead to the great difficulty of accurate, complete follow-up of the earthquake victims. There is great difference in the completeness and comprehensiveness of the wounded medical records in the existing literatures. This creates great difficulty for the statistical analysis of data and further study. Combined with the enrolled studies were not standard randomized controlled study may lead to the biased results of this study. Further collection of more and more comprehensive, standardized multidisciplinary clinical data is needed, and the follow-up of ERHI patients should be strengthened to obtain more precise results.