title: Injuries and post-traumatic stress following historic tornados: Alabama, April 2011.
abstract: OBJECTIVE
  We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011.
  
  
  METHODS
  We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls.
  
  
  RESULTS
  Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤ 15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10-23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04-0.40), bathrooms (OR, 0.22; 95% CI: 0.06-0.78), hallways (OR, 0.31; 95% CI: 0.11-0.90) and closets (OR, 0.25; 95% CI: 0.07-0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09-0.49), television (aOR, 0.45; 95% CI: 0.24-0.83), and sirens (aOR, 0.50; 95% CI: 0.30-0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events.
  
  
  CONCLUSIONS
  Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available.
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America ; Centers for Disease Control and Prevention (CDC), Scientific Education and Professional Development Program Office, Division of Applied Sciences, Epidemic Intelligence Service, Atlanta, Georgia, United States of America ; Current affiliation: Medical University of Vienna, Center for Public Health, Department of General Practice and Family Medicine, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederkrotenthaler
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America ; Centers for Disease Control and Prevention (CDC), Scientific Education and Professional Development Program Office, Division of Applied Sciences, Epidemic Intelligence Service, Atlanta, Georgia, United States of America.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Parker
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ovalle
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Noe
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division Of Environmental Hazards & Health Effects, Atlanta, Georgia, United States of America.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Noe
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America.
authors.forename: Jeneita
authors.initials: J
authors.lastname: Bell
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Division of Analysis, Research, and Practice Integration, Atlanta, Georgia, United States of America.
authors.forename: Likang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response, Atlanta, Georgia, United States of America ; Alabama Department of Public Health (ADPH), Montgomery, Alabama, United States of America.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Morrison
authors.affiliation: Agency for Toxic Substances and Disease Registry (ATSDR), Division Of Toxicology And Human Health Sciences, Geospatial Research, Analysis And Services Program, Atlanta, Georgia, United States of America.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Mertzlufft
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America.
authors.forename: David E
authors.initials: DE
authors.lastname: Sugerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D004190:Disasters; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D055869:Tornadoes; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult