Source

This study received approval from the Ethics Committee of the People’s Hospital of Linxia Hui Autonomous Prefecture (LZYY-LLSP-2024-01). This research began in March 2024. This study conducted a retrospective analysis of the clinical records of 166 patients with earthquake-related injuries admitted to the People’s Hospital of Linxia Hui Autonomous Prefecture and the Traditional Chinese Medicine Hospital of Linxia Hui Autonomous Prefecture following the 6.2 magnitude earthquake on December 18, 2023 in Jishishan (Figure 1).

Figure 1. Data Inclusion/Exclusion Flow Diagram.

Observations

Basic Characteristics of Earthquake Casualties

This study included a total of 166 hospitalized casualties, comprising 142 patients admitted to the People’s Hospital of Linxia Hui Autonomous Prefecture and 24 patients at the Traditional Chinese Medicine Hospital of Linxia Hui Autonomous Prefecture. Among the injured, 54.2% were male, 78.3% were married, and 74.7% were farmers. Ages ranged from four months to 85 years, with 18 ∼ 65 years being the majority, accounting for 61.5%. The injured came from various ethnic groups, with Hui (44.1%) being the majority. This is detailed in Table 1.

Table 1. Distribution of Basic Characteristics for Earthquake Casualties

Distribution of Injuries Category for Earthquake Casualties

Among the injured, 40.3% presented with a single injury. The most frequent injury was fractures (64.2%), followed by soft-tissue injuries (8.9%), neurological injuries (5.9%), preterm labor (3.0%), cerebral hemorrhage (3.0%), subcutaneous hematomas (3.0%), extrusion injuries (3.0%), visceral injuries (3.0%), skin injuries (3.0%), oculo-facial injury (1.5%), and pulmonary contusion (1.5%); Table 2.

Table 2. Distribution of Injuries Category for Earthquake Casualties

In this study, 28.3% presented with two injuries; the most common combination was pulmonary contusion and fracture (44.7%). In this study, 14.5% presented with three injuries, and the most prevalent combination was pulmonary contusion, fracture, and soft tissue injury (25.0%). In this study, 12.1% presented with four injuries, and the most frequently encountered combination was pulmonary contusion, fracture, skin injury, and subcutaneous hematoma (20.0%). In this study, 4.2% presented with five injuries, most common among these was pulmonary contusion, fracture, nerve injury, subcutaneous hematoma, and cerebral hemorrhage which accounted for 28.6%. Lastly, only one (0.6%) was diagnosed with six injuries: pulmonary contusion, fractures, soft tissue injuries, skin injuries, crush injuries, and cerebral hemorrhage. Moreover, 78.9% presented with fractures and 36.8% with pulmonary contusions, while and 34.9% presented with a combination of fractures and pulmonary contusions in the total cases.

Distribution of Treatment Measures for Earthquake Casualties

In the analysis of treatment approaches, 28.9% of earthquake victims received only Western medicine. Furthermore, 25.9% were treated with a combination of Chinese and Western medicine. Surgical interventions combined with Western medicine were administered to 22.9%, and 22.3% received surgical treatment combined with Chinese and Western medicines (Table 3).

Table 3. Distribution of Treatment Measures for Earthquake Casualties

Distribution of Surgical Treatment Items for Earthquake Casualties

In total, 75 cases (45.2%) of the earthquake victims required surgical treatment. Of these, 17.4% underwent internal fixation for fractures, with the surgical sites primarily involving three cases of ankle, three lumbar vertebrae, two patellar, one femoral, one radius, one rib, one metatarsal, and one case involving both the patella and phalanges. Additionally, sutures accounted for 17.4%, with the surgical sites primarily encompassing nine cases of skin, three scalp, and one forearm tendon. There were 12.0% that required arterial puncture, alongside 6.7% of traction treatment, resections, central venous cannulation, and arterial puncture. This is detailed in Table 4.

Table 4. Distribution of Surgical Treatment Items for Earthquake Casualties

Distribution of Outcomes for Earthquake Casualties

In this study, 53.0% were treated and discharged from the hospital and 47.0% were transferred to provincial hospitals for on-going treatment (Table 5). In addition, the outcome of injured patients with differing injury conditions was different, as detailed in Table 6.

Table 5. Distribution of Outcomes for Earthquake Casualties

Table 6. Outcome Distribution of Different Injury Conditions

Analysis

In this study, the data revealed a slightly higher prevalence of males compared to females. Additionally, a significant proportion of the injured fell within the 18-65 age group (61.5%), which may be associated with varying levels of exposure and behavior during the earthquake event. There are Han, Baoan, Dongxiang, Salar, Hui, Tu, and Tibetan ethnic groups in Jishishan County. ⁴ The injured individuals in this study included several ethnic groups, with the Hui group making up the largest proportion at 44.1%. Furthermore, farmers made up the majority of the injured population, likely because the earthquake’s epicenter was primarily located in rural areas, where buildings are generally less resilient to seismic activity.

The injury categories among earthquake casualties in this study were multifaceted. A systematic review indicated that multiple injuries are a common feature among earthquake casualties, with approximately one-third to one-half of these individuals presenting with more than one type of injury. ^{Reference Clover, Jemec and Redmond10} Zhao’s retrospective study of the Wenchuan earthquake (2008) highlighted that multiple injuries were a significant characteristic, with a maximum of five combined injuries recorded. ^{Reference Lu-Ping, Rodriguez-Llanes and Qi11} Kang, et al’s investigation on the Lushan earthquake (2013) found that the most common multiple injuries were soft tissue contusions and lacerations, and only 11.2% of the wounded had multiple injuries of Type 3 or above. ^{Reference Kang, Tang and Liu12} In the study, two injuries accounted for 28.3%, three injuries represented 14.5%, four injuries accounted for 12.1%, 4.2% had five injuries, and only 0.6% had six injuries. This indicated that multiple injuries are a critical feature among those injured in this earthquake, with the highest observed combination being six injuries.

The analysis revealed that 78.9% of earthquake casualties involved fractures, confirming that fractures were the predominant type of injury in this case. This finding aligns with reports indicating a higher incidence of fractures in studies of other major earthquakes, such as those in Wenchuan, Yushu (2010), Lushan, and Nepal (2015). ^{Reference Lu-Ping, Rodriguez-Llanes and Qi11–Reference Kang, Zhang and Liang14} One study identified pulmonary contusion as a reliable indicator of chest injury severity, ^{Reference Freixinet, Beltrán and Rodríguez15} while another report noted that chest crush injuries sustained during the Sichuan earthquake (2008) were life-threatening and could lead to multiple fractures and lung injuries. ^{Reference Dong, Yang and Chen16} In the research, 36.8% of earthquake casualties had pulmonary contusion, and 34.9% presented with both fractures and pulmonary contusion. Research indicates that the incidence of fractures and related injuries in earthquakes is associated with patients’ body postures and living conditions at the time of the earthquake. ^{Reference Maruo and Matumoto17} Since this earthquake occurred at 23:59 on a cold winter night, many individuals were asleep. This may have led to reduced earthquake perception and emergency response capabilities, exacerbated by a subsequent power outage.

In this study, 45.2% of participants underwent surgical treatment, which primarily involved internal fixation of fractures and suturing. Studies of prior earthquakes, including the Wenchuan and Lushan earthquakes, have identified internal fixation and suturing as the most common surgical interventions. ^{Reference Kang, Tang and Liu12,Reference Guo-dong, Pu-jie and Su-xing18} Furthermore, surgical treatment of fractures has been recognized as a primary treatment strategy in various earthquake scenarios, such as the Bam earthquake (2003), the Haiti earthquake (2010), the Nepal earthquake, and the Jiuzhaigou earthquake (2017) in Sichuan Province. ^{Reference Freixinet, Beltrán and Rodríguez15,Reference Mohebbi, Mehrvarz and Saghafinia19–Reference Shi, Liu and Li21}

Experience in providing medical treatment to earthquakes victims shows that the critical period for effective care is within the first 72 hours after the disaster. ^{Reference Bulut, Fedakar and Akkose22} The People’s Hospital of Linxia Hui Autonomous Prefecture and the Traditional Chinese Medicine Hospital of Linxia Hui Autonomous Prefecture sent a medical rescue team to the earthquake-hit area immediately after the earthquake to carry out on-site treatment, screening, transfer of the injured, and psychological counseling. They were the first to admit and treat the injured transferred from Jishishan County. The emergency department opened a green channel, conducted pre-screening, and triage. Following the principle of “Four Concentrations,” a quasi-intensive-care-unit ward was rapidly established. Moving forward, it is crucial to focus on advancing and enhancing medical technologies and capabilities, enabling more effective responses to future public health emergencies.

To prevent earthquakes in high-altitude cold areas, a comprehensive “anti-seismic and cold-resistant” strategy is necessary. This involves combining local building materials, traditional craftsmanship, and modern technology to enhance building resilience and seismic performance, while also optimizing the emergency response system. Medical treatment should be based on the principle of laddering: first-level response (the golden 72 hours), with priority given to patients experiencing hypoxia combined with traumatic shock. Secondary triage, along with multidisciplinary collaboration, is essential for treating the injured. In addition, post-disaster psychological intervention is necessary.

The primary characteristics of injuries sustained by earthquake casualties in this study included fractures and multiple traumas. Suturing and internal fixation were the most common surgical interventions. The core findings of this study provide an important reference for regionalized prevention and treatment of earthquake injury in high-altitude regions. This will enhance the response capabilities of regional hospitals in handing earthquake disasters.

The limitations of this study include: (1) the sample of the injured only covers the cases admitted to tertiary hospitals, which may introduce selection bias; (2) currently, there is no comparable data on earthquake casualties available for analysis; and (3) due to limited information on earthquake victims and the complexity of post-earthquake reconstruction efforts, follow-up work for the injured is difficult to carry out, leading to a lack of follow-up data.