Clinical Profile of Thorax and Lung Injuries Associated with the 2011 Van Earthquake in Turkey

Abstract

The 7.2 and 5.6 magnitude earthquake that struck Turkey on October 23 and November 9, 2011, was one of the deadliest earthquakes in recent decade. Our aim is to determine the clinical profile of crush thoracic traumas resulting from the massive Van earthquake. A retrospective review was undertaken of 39 intervention for chest traumas. Sex distrubition was 21 female and 18 male patients. Thoracic cage, pulmonary parenchyma, and pleura traumas were included in the study. Among the total of 425 hospitalized patients, 39 (9.1%) were thorax and lung injuries. Pneumothorax and rib fractures were the two most frequent pathologies. There were pneumothorax or hemothorax in 31 (79%) patients, bronch ruptures in 2 (5.1%) patients, diaphragmatic ruptures in 2 (5.1%) patients, flail chest in 2 (5.1%) patients and sternal fracture was detected in 2 (5.1%) patients. Totally, 76 ribs fractures were found in 27 (69%) patients, There were 36 (92%) patients with pulmonary parenchymal injuries and 31 (79%) with pleural injuries. Thoracotomy was performed in 4 (10%) patients, while 37 (95%) patients underwent tube thoracostomy. Carinal reconstruction was performed in a patient with bronchus and trachea injuries. Four patients (10%) with severe trauma developed Acute Respiratory Distres Syndrome (ARDS) and two of them died because of developing ARDS. After the patients are admitted to the hospital, we should use an individualized treatment according to the patients recent clinical history and examination. At the same time, traumatic chest injury should be considered in planning the medical response strategies

Keywords

• Earthquake, thoracic trauma, lung injury

Clinical Profile of Thorax and Lung Injuries Associated with the 2011 Van Earthquake in Turkey

Öz

Van’da 23 Ekim ve 9 Kasım’da 7.2 ve 5.6 şiddetinde son 10 yılın en şiddetli depremi meydana geldi. Amacımız, şiddetli Van depreminden dolayı toraks travmasına maruz kalan hastaların klinik profilini ve sonuçlarını araştırmaktır. Göğüs travmasına maruz kalan 39 hasta retrospektif olarak değerlendirildi. Yaş dağılımı ele alındığında 21 olgu bayan, 18 olgu erkekti. Göğüs kafesi, akciğer parenkimi, plevral yaralanma durumu değerlendirildi. Deprem nedeniyle toplamda, yatırılan 425 hastanın 39’u (%9.1) toraks travması ve akciğer yaralanmasına maruz olgulardı. Pnömotoraks ve kot fraktürleri, en sık görülen 2 önemli patolojiydi. Pnömotoraks ve/veya hemotoraks 31 hastada (%79), bronş rüptürü 2 olguda (%5.1), diyafragma rüptürü 2 olguda (%5.1), yelken göğüs 2 olguda (%5.1), sternal kırık 2 olguda (%5.1) görüldü. Tesbit edilen kırık kot sayısı 76 idi (27 hastada, %69). Pulmoner parenkimal yaralanmalı olgu sayısı 36 olgu (%92), plevral yaralanmalı olgu sayısı 31 (%79) idi. Tüp torakostomi uygulanan olgu sayısı 37 (%95) iken, torakotomi 4 olguya (%10) uygulandı. Akut solunum yetmezliği 4 olguda (%10) gelişti, bu olgulardan ikisi eksitus oldu.Hastaneye hasta kabulü sonrası, hastaların yakın zamandaki klinik öykü ve değerlendirmesi yapılarak tedavi şekillendirilmelidir. Travmatik göğüs yaralanmalarında aynı zamanda tedavi stratejileri ve medikal tedavi seçenekleri de iyi değerlendirilmelidir

Anahtar Kelimeler

• Deprem, göğüs travaması, akciğer yaralanması

References

1. Iskit SH, Alpay H, Tugtepe H, et al. Analysis of 33 pedi- atric trauma victims in the 1999 Marmara, Turkey earth- quake. J Pediatr Surg 2001;36(2):368-72.
2. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37:975–9.
3. Virgos Senor B, Nebra Puertas AC, Sanchez Polo C, Broto Civera A, Suarez Pinilla MA. Predictors of outcome in blunt chest trauma. Arch Bronconeumol 2004;40:489–4.
4. Sirmali M, Turut H, Topcu S, et al. A comprehensive analy- sis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 2003;24:133–8.
5. Yoshimura N, Nakayama S, Nakagiri K, Azami T, Ataka K, Ishii N. Profile of chest injuries arising from the 1995 Southern Hyogo Prefecture earthquake. Chest 1996;110:759–61.
6. Ghodsi SM, Zargar M, Khaji A, Karbakhsh M. Chest in- jury in victims of Bam earthquake. Chin J Traumatol 2006;9:345–348
7. Ardalan A. Disaster Epidemiology Lessons From Bam Earthquake Dec 26, 2003 Iran. University of Pittsburg. Available from: http://www.pitt.edu/~super1/lecture/ lec15221/001.htm
8. McArthur DL, Peek-Asa C, Kraus JF (2000). Injury hospital- izations before and after the 1994 Northridge, California earthquake. Am J Emerg Med;18(4):361-66.

9. Schultz CH, Koenig KL, Noji EK. A medical disaster re- sponse to reduce immediate mortality after an earth- quake. N Engl J Med 1996;334(7):438-44.
10. Peek-Asa C, Ramirez M, Seligson H, Shoaf K. Seismic, structural, and individual factors associated with earth- quake related injury. Inj Prev 2003;9(1):62-6.
11. Freixinet J, Beltran J, Rodriguez PM, et al. Indicators of severity in chest trauma. Arch Bronconeumol.2008;44: 257-62.
12. Livoni JP, Barcia TC. Fracture of the first and second rib: İncidence of vascular injury relative to type of fracture. Radiology 1982;145:31-3.
13. Bastos R, Calhoon JH, Baisten CE. Flail chest and pulmo- nary contusion. Semin Thorac Cardiovasc Surg 2008;20: 39-45.
14. Flagel BT, Shogan B, John P, Lavery RF CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma 2008;64:905–11
15. Ozdogan S, Hocaoglu A, Caglayan B, Imamoglu OU, Aydin D. Thorax and Lung injuries arising from the two earth- quake in Turkey in 1999. Chest 2001;120:1163-6.
16. Hall A, Johnson K. The imaging of paediatric thoracic trauma. Paediatr Respir Rew 2002;3:241-7.
17. Bar-Dayan Y, Beard P, Mankuta D, et al. An earthquake disaster in Turkey: an overview of the experience of the Israeli Defence Forces Field Hospital in Adapazarı. Disasters 2000;24:262-70.
18. Wolf Y, Bar-Dayan Y, Mankuta D, et al. An earthquake di- saster in Turkey: assessment of the need for plastic sur- gery services in a crisis intervention field hospital. Plast Reconstr Surg 2001;107:163-70.
19. Liang NJ, Shih YT, Shih FY, et al. Disaster epidemiol- ogy and medical response in the Chi-Chi earthquake in Taiwan. Ann Emerg Med 2001;38(5):549-55.
20. Sarisozen B, Durak K. Extremity injuries in children re- sulting from the 1999 Marmara earthquake: an epidemio- logic study. J Pediatr Orthop B 2003;12(4):288-91.