title: Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center.
abstract: OBJECTIVE
  The April 27, 2011, tornados that affected the southeastern US resulted in 248 deaths in the state of Alabama. The University of Alabama at Birmingham (UAB) Medical Center, the largest Level I trauma center in the state, triaged and treated a large number of individuals who suffered traumatic injuries during these events, including those requiring neurosurgical assessment and treatment.
  
  
  METHODS
  A retrospective review of all adult patients triaged at UAB Medical Center during the April 27, 2011, tornados was conducted. Those patients who were diagnosed with and treated for neurosurgical injuries were included in this cohort.
  
  
  RESULTS
  The Division of Neurosurgery at UAB Medical Center received 37 consultations in the 36 hours following the tornado disaster. An additional patient presented 6 days later, having suffered a lumbar spine fracture that ultimately required operative intervention. Twenty-seven patients (73%) suffered injuries as a direct result of the tornados. Twenty-three (85%) of these 27 patients experienced spine and spinal cord injuries. Four patients (15%) suffered intracranial injuries and 2 patients (7%) suffered combined intracranial and spinal injuries. The spinal fractures that were evaluated and treated were predominantly thoracic (43.5%) and lumbar (43.5%). The neurosurgery service performed 14 spinal fusions, 1 ventriculostomy, 2 halo placements, 1 diagnostic angiogram, 1 endovascular embolectomy, and 1 wound debridement and lavage. Twenty-two patients (81.5%) were neurologically intact at discharge and all but 4 had 1 year of follow-up. Three patients had persistent deficits from spinal cord injuries and there was 1 death in a patient with multisystem injuries in whom no procedures were performed. Two patients experienced postoperative complications in the form of 1 wound infection and 1 stroke.
  
  
  CONCLUSIONS
  The April 27, 2011, tornados in Alabama produced significant neurosurgical injuries that primarily involved the spine. There were a disproportionate number of patients with thoracolumbar fractures, a finding possibly due to the county medical examiner's postmortem findings that demonstrated a high prevalence of fatal cervical spine and traumatic brain injuries. The UAB experience can be used to aid other institutions in preparing for the appropriate allotment of resources in the event of a similar natural disaster.
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Miller
authors.forename: Holly A
authors.initials: HA
authors.lastname: Zywicke
authors.forename: James B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Whisenhunt
authors.forename: Mamerhi O
authors.initials: MO
authors.lastname: Okor
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pritchard
authors.forename: Mark N
authors.initials: MN
authors.lastname: Hadley
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015995:Prevalence; D012189:Retrospective Studies; D013123:Spinal Fusion; D013124:Spinal Injuries / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D055869:Tornadoes; D016896:Treatment Outcome; D014696:Ventriculostomy; D055815:Young Adult