title: Epidemiology of injuries due to tropical cyclones in Hong Kong: a retrospective observational study.
abstract: BACKGROUND
  Tropical cyclones are huge circulating masses of wind which form over tropical and sub-tropical waters. They affect an average of 78 million people each year. Hong Kong is a large urban centre with a population of just over 7 million which is frequently affected by tropical cyclones. We aimed to describe the numbers and types of injuries due to tropical cyclones in Hong Kong, as well as their relation to tropical cyclone characteristics.
  
  
  METHODS
  The records of all patients presenting to Hong Kong's public hospital emergency departments from 1st January 2004 to 31st December 2009 with tropical cyclone related injuries were reviewed and information regarding patient and injury characteristics was collected. Meteorological records for the relevant periods were examined and data on wind speed, rainfall and timing of landfall and warning signals was recorded and compared with the timing of tropical cyclone related injuries.
  
  
  RESULTS
  A total of 460 tropical cyclone related injuries and one fatality across 15 emergency departments were identified during the study period. The mean age of those injured was 48 years and 48% were female. 25.4% of injuries were work related. The head (33.5%) and upper limb (32.5%) were the most commonly injured regions, with contusions (48.6%) and lacerations (30.2%) being the most common injury types. Falls (42.6%) were the most common mechanism of injury, followed by being hit by a falling or flying object (22.0%). In univariable analysis the relative risk of injury increased with mean hourly wind speed and hourly maximum gust. Multivariable analysis, however, showed that relative risk of injury increased with maximum gust but not average wind speed, with relative risk of injury rising sharply above maximum gusts of greater than 20 m/s. Moderate wind speed with high gust (rather than high average and high gust) appears to be the most risky situation for injuries. Relative risk of injury was not associated with rainfall. The majority of injuries (56%) occurred in the 3h before and after a tropical cyclone's closest proximity to Hong Kong, with relative risk of injury being highest mid-morning.
  
  
  CONCLUSIONS
  In tropical cyclone related injuries in Hong Kong the head and upper limb are the most commonly affected sites with falls and being hit by a falling or flying object being the most common mechanisms of injury. Hourly maximum gust appears to be more important that mean hourly wind speed in determining risk of injury. These findings have implications for injury prevention measures and emergency planning in Hong Kong and other regions effected by tropical cyclones.
authors.affiliation: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region. katerotheray@gmail.com
authors.forename: K R
authors.initials: KR
authors.lastname: Rotheray
authors.forename: P
authors.initials: P
authors.lastname: Aitken
authors.forename: W B
authors.initials: WB
authors.lastname: Goggins
authors.forename: T H
authors.initials: TH
authors.lastname: Rainer
authors.forename: C A
authors.initials: CA
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D055867:Cyclonic Storms; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014329:Tropical Climate; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*; D014950:Wounds, Penetrating / Q000453:epidemiology*; D055815:Young Adult