title: Multiple injuries after earthquakes: a retrospective analysis on 1,871 injured patients from the 2008 Wenchuan earthquake.
abstract: BACKGROUND
  Multiple injuries have been highlighted as an important clinical dimension of the injury profile following earthquakes, but studies are scarce. We investigated the pattern and combination of injuries among patients with two injuries following the 2008 Wenchuan earthquake. We also described the general injury profile, causes of injury and socio-demographic characteristics of the injured patients.
  
  
  METHODS
  A retrospective hospital-based analysis of 1,871 earthquake injured patients, totaling 3,177 injuries, admitted between 12 and 31 May 2008 to the People's Hospital of Deyang city (PHDC). An electronic, webserver-based database with International Classification of Diseases (ICD)-10-based classification of earthquake-related injury diagnoses (IDs), anatomical sites and additional background variables of the inpatients was used. We analyzed this dataset for injury profile and number of injuries per patient. We then included all patients (856) with two injuries for more in-depth analysis. Possible spatial anatomical associations were determined a priori. Cross-tabulation and more complex frequency matrices for combination analyses were used to investigate the injury profile.
  
  
  RESULTS
  Out of the 1,871 injured patients, 810 (43.3%) presented with a single injury. The rest had multiple injuries; 856 (45.8%) had two, 169 (9.0%) patients had three, 32 (1.7%) presented with four injuries, while only 4 (0.2%) were diagnosed with five injuries. The injury diagnoses of patients presenting with two-injuries showed important anatomical intra-site or neighboring clustering, which explained 49.1% of the combinations. For fractures, the result was even more marked as spatial clustering explained 57.9% of the association pattern. The most frequent combination of IDs was a double-fracture, affecting 20.7% of the two-injury patients (n = 177). Another 108 patients (12.6%) presented with fractures associated with crush injury and organ-soft tissue injury. Of the 3,177 injuries, 1,476 (46.5%) were fractures. Most injuries were located in the head (22.9%) and lower extremities (30.8%).
  
  
  CONCLUSIONS
  Multiple injuries are put forward as an important component of the injury profile after this earthquake. A pattern of injury combinations and spatial aggregation of injuries was also found. Clinical diagnosis and treatment should be adapted to care of these patients. More studies are needed to generalize these findings.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Lu-Ping
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rodriguez-Llanes
authors.forename: Wu
authors.initials: W
authors.lastname: Qi
authors.forename: Barbara
authors.initials: B
authors.lastname: van den Oever
authors.forename: Lina
authors.initials: L
authors.lastname: Westman
authors.forename: Manuel
authors.initials: M
authors.lastname: Albela
authors.forename: Pan
authors.initials: P
authors.lastname: Liang
authors.forename: Chen
authors.initials: C
authors.lastname: Gao
authors.forename: Zhang
authors.initials: Z
authors.lastname: De-Sheng
authors.forename: Melany
authors.initials: M
authors.lastname: Hughes
authors.forename: Johan
authors.initials: J
authors.lastname: von Schreeb
authors.forename: Debarati
authors.initials: D
authors.lastname: Guha-Sapir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D004190:Disasters / Q000706:statistics & numerical data; D055866:Earthquakes / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult