Radiological findings of February 2023 twin earthquakes-related spine injuries

BACKGROUND The February 6,2023,twin earthquakes in Türkiye caused significant structural damage and a high number of injuries,particularly affecting the spine,which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.AIM To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6,2023 twin earthquakes in Türkiye.METHODS With the approval of the institutional ethics committee,1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6,2023,were retrospectively analyzed for spine injuries.RESULTS Spine computed tomography(CT)scans were performed in 192 of 238 patients with a suspected spinal injury,42 of whom also had an magnetic resonance imaging(MRI).In 86 of 192 patients(44.79%;M:F=33:53)a spinal fracture was detected on CT and in 33 of 42 patients(78.57%;M:F=20:13)a spinal injury was found on MRI.Of the 86 patients in whom vertebral injury was detected,fractures were detected in the Denis-B group in 33,Denis-C in 4,Denis-D in 20 and Denis-E in 11 patients.Among the vertebral bodies:40"compression fractures",17"burst fractures",5"translational dislocation fractures",5"flexion-distraction fractures"and 58"prolonged forced fetal posture fractures"were detected.In addition,isolated transverse or spinous process fractures were found in eighteen vertebrae.CONCLUSION Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6,2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios,and emphasizing the"prolonged forced fetal posture"damage we encountered in earthquake victims who remained under the collapse for a long time.

Follow-up evaluation with ultrasonography of peripheral nerve injuries after an earthquake

Published data on earthquake-associated peripheral nerve injury is very limited. Ultrasonography has been proven to be efficient in the clinic to diagnose peripheral nerve injury. The aim of this study was to assess the role of ultrasound in the evaluation of persistent peripheral nerve injuries 1 year after the Wenchuan earthquake. Thirty-four patients with persistent clinical symptoms and neurologic signs of impaired nerve function were evaluated with sonography prior to surgi- cal repair. Among 34 patients, ultrasonography showed that 48 peripheral nerves were entrapped, and 11 peripheral nerves were disrupted. There was one case of misdiagnosis on ultrasonogra- phy. The concordance rate of ultrasonographic findings with those of surgical findings was 98%. A total of 48 involved nerves underwent neurolysis and the symptoms resolved. Only five nerves had scar tissue entrapment. Preoperative and postoperative clinical and ultrasonographic results were concordant, which verified that ultrasonography is useful for preoperative diagnosis and postoperative evaluation of injured peripheral nerves.

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classiifed into three types： type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open tran-section nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmaco-therapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity de-clined with increasing duration of being trapped. In the ifrst year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor （0 or 1） after a 1-year period of treatment, further treatment was not effective.

Key technologies of earthquake early warning system for China’s high-speed railway

Purpose–The purpose of this study is to introduce the top-level design ideas and the overall architecture of earthquake early-warning system for high speed railways in China,which is based on P-wave earthquake early-warning and multiple ways of rapid treatment.Design/methodology/approach–The paper describes the key technologies that are involved in the development of the system,such as P-wave identification and earthquake early-warning,multi-source seismic information fusion and earthquake emergency treatment technologies.The paper also presents the test results of the system,which show that it has complete functions and its major performance indicators meet the design requirements.Findings–The study demonstrates that the high speed railways earthquake early-warning system serves as an important technical tool for high speed railways to cope with the threat of earthquake to the operation safety.The key technical indicators of the system have excellent performance:The first report time of the P-wave is less than three seconds.From the first arrival of P-wave to the beginning of train braking,the total delay of onboard emergency treatment is 3.63 seconds under 95%probability.The average total delay for power failures triggered by substations is 3.3 seconds.Originality/value–The paper provides a valuable reference for the research and development of earthquake early-warning system for high speed railways in other countries and regions.It also contributes to the earthquake prevention and disaster reduction efforts.

Geological risk assessment of traffic engineering construction among 7.0-8.5 magnitude earthquake areas:Practice from the Sichuan-Tibet transport corridor in the eastern Tibetan Plateau

At least 13 active fault zones have developed in the Ya'an-Linzhi section of the Sichuan-Tibet transport corridor,and there have been undergone 17 MS≥7.0 earthquakes,the largest earthquake is 1950 Chayu MS 8.5 earthquake,which has very strong seismic activity.Therefore,carrying out engineering construction in the Sichuan-Tibet transport corridor is a huge challenge for geological technological personnel.To determining the spatial geometric distribution,activity of active faults and geological safety risk in the Sichuan-Tibet transport corridor.Based on remote sensing images,ground surveys,and chronological tests,as well as the deep geophysical and current GPS data,we investigated the geometry,segmentation,and paleoearthquake history of five major active fault zones in the Ya'an-Linzhi section of the Sichuan-Tibet transport corridor,namely the Xianshuihe,Litang,Batang,Jiali-Chayu and Lulang-Yigong.The five major fault zones are all Holocene active faults,which contain strike-slip components as well as thrust or normal fault components,and contain multiple branch faults.The Selaha-Kangding segment of the Xianshuihe fault zone,the Maoyaba and Litang segment of the Litang fault zone,the middle segment(Yigong-Tongmai-Bomi)of Jiali-Chayu fault zone and Lulang-Yigong fault zone have the risk of experiencing strong earthquakes in the future,with a high possibility of the occurrence of MS≥7.0 earthquakes.The Jinsha River and the Palong-Zangbu River,which is a high-risk area for geological hazard chain risk in the Ya'an-Linzhi section of the Sichuan-Tibet transport corridor.Construction and safe operation Ya'an-Linzhi section of the Sichuan-Tibet transport corridor,need strengthen analysis the current crustal deformation,stress distribution and fault activity patterns,clarify active faults relationship with large earthquakes,and determine the potential maximum magnitude,epicenters,and risk range.This study provides basic data for understanding the activity,seismicity,and tectonic deformation patterns of the regional faults in the Sichuan-Tibet transport corridor.

The MW5.5 earthquake on August 6,2023,in Pingyuan,Shandong,China:A rupture on a buried fault

On August 6,2023,a magnitude MW5.5 earthquake struck Pingyuan County,Dezhou City,Shandong Province,China.This event was significant as no large earthquakes had been recorded in the region for over a century,and no active fault had been previously identified.This study collects 1309 P-wave arrival times and 866 S-wave arrival times from 74 seismic stations less than 200 km to the epicenter to constrain the spatial distribution of the mainshock and its 125 early aftershocks by the double difference earthquake relocation method,and selects 864 P-waveforms from 288 stations located within 800 km of the epicenter to constrain the focal mechanism solution of the mainshock through centroid moment tensor inversion.The relocation and the inversion indicate,the Pingyuan MW5.5 earthquake was caused by a rupture on a buried fault,likely an extensive segment of the Gaotang fault.This buried fault exhibited a dip of approximately 75°to the northwest,with a strike of 222°,similar to the Gaotang fault.The rupture initiated at the depth of 18.6 km and propagated upward and northeastward.However,the ground surface was not broken.The total duration of the rupture was~6.0 s,releasing the scalar moment of 2.5895×1017 N·m,equivalent to MW5.54.The moment rate reached the maximum only 1.4 seconds after the rupture initiation,and the 90%scalar moment was released in the first 4.6 s.In the first 1.4 seconds of the rupture process,the rupture velocity was estimated to be 2.6 km/s,slower than the local S-wave velocity.As the rupture neared its end,the rupture velocity decreased significantly.This study provides valuable insights into the seismic characteristics of the Pingyuan MW5.5 earthquake,shedding light on the previously unidentified buried fault responsible for the seismic activity in the region.Understanding the behavior of such faults is crucial for assessing seismic hazards and enhancing earthquake preparedness in the future.

Rapid report of source parameters of 2023 M6.2 Jishishan,Gansu earthquake sequence

The M6.2 earthquake in Jishishan,Gansu Province,on December 18,2023,caused extraordinary earthquake disasters.It was located in the northern part of the north−south seismic zone,which is a key area for earthquake monitoring in China.The newly built dense strong motion stations in this area provide unprecedented conditions for high-precision earthquake relocation,especially the earthquake focal depth.This paper uses the newly built strong motion and traditional broadband seismic networks to relocate the source locations of the M3.0 and above aftershocks and to invert their focal mechanisms.The horizontal error of earthquake location is estimated to be 0.5−1 km,and the vertical error is 1−2 km.The focal depth range of aftershocks is 9.6−14.6 km,distributed in a 12-km-long strip with SSE direction.Aftershocks in the south are more concentrated horizontally and vertically,while aftershocks in the north are more scattered.The focal mechanisms of the main shock and aftershocks are relatively consistent,and the P-axis orientation is consistent with the regional strain direction.There is a seismic blank area of M3.0 and above,about 3−5 km between the main shock and aftershocks.It is suggested that the energy released by the main shock rupture is concentrated in this area.Based on the earthquake location and focal mechanism of the main shock,it is inferred that the Northern Lajishan fault zone is the seismogenic structure of the main shock,and the main shock did not occur on the main fault,but on a secondary fault.The initial rupture depth and centroid depth of the main shock were 12.8 and 14.0 km,respectively.The source rupture depth may not be the main reason for the severe earthquake disaster.

Characterization and spatial analysis of coseismic landslides triggered by the Luding Ms 6.8 earthquake in the Xianshuihe fault zone, Southwest China

On September 5, 2022, a magnitude Ms 6.8 earthquake occurred along the Moxi fault in the southern part of the Xianshuihe fault zone located in the southeastern margin of the Tibetan Plateau,resulting in severe damage and substantial economic loss. In this study, we established a coseismic landslide database triggered by Luding Ms 6.8 earthquake, which includes 4794 landslides with a total area of 46.79 km^(2). The coseismic landslides primarily consisted of medium and small-sized landslides, characterized by shallow surface sliding. Some exhibited characteristics of high-position initiation resulted in the obstruction or partial obstruction of rivers, leading to the formation of dammed lakes. Our research found that the coseismic landslides were predominantly observed on slopes ranging from 30° to 50°, occurring at between 1000 m and 2500 m, with slope aspects varying from 90° to 180°. Landslides were also highly developed in granitic bodies that had experienced structural fracturing and strong-tomoderate weathering. Coseismic landslides concentrated within a 6 km range on both sides of the Xianshuihe and Daduhe fault zones. The area and number of coseismic landslides exhibited a negative correlation with the distance to fault lines, road networks, and river systems, as they were influenced by fault activity, road excavation, and river erosion. The coseismic landslides were mainly distributed in the southeastern region of the epicenter, exhibiting relatively concentrated patterns within the IX-degree zones such as Moxi Town, Wandong River basin, Detuo Town to Wanggangping Township. Our research findings provide important data on the coseismic landslides triggered by the Luding Ms 6.8 earthquake and reveal the spatial distribution patterns of these landslides. These findings can serve as important references for risk mitigation, reconstruction planning, and regional earthquake disaster research in the earthquake-affected area.

Strong Earthquake Model of North China Craton: A Case of 2023 Mw 5.5 Earthquake in Pingyuan County, Shandong Province, China

North China is one of the high-risk areas for destructive strong earthquakes in China's Mainland, with a history of numerous significant seismic events. On August 6, 2023, an Mw5.5 earthquake struck Pingyuan County, Dezhou City, in Shandong Province, China. This earthquake was the largest in the eastern North China Craton(NCC) since the Tangshan earthquake of 1976. Due to the absence of surface ruptures, the fault responsible for the Pingyuan Mw5.5 earthquake remains unclear. To reveal the subsurface geological structure near the earthquake epicenter, this study utilized highresolution two-dimensional seismic reflection profiles to interpret pre-existing faults.

The 2023 Turkey earthquake doublet: Earthquake relocation, seismic tomography, and stress field inversion

On February 6,2023,two earthquakes with magnitudes of M_(W) 7.8 and M_(W) 7.5 struck southeastern Turkey,causing significant casualties and economic losses.These seismic events occurred along the East Anatolian Fault Zone,a convergent boundary between the Arabian Plate and the Anatolian Subplate.In this study,we analyze the M_(W) 7.8 and M_(W) 7.5 earthquakes by comparing their aftershock relocations,tomographic images,and stress field inversions.The earthquakes were localized in the upper crust and exhibited steep dip angles.Furthermore,the aftershocks occurred either close to the boundaries of low and high P-wave velocity anomaly zones or within the low P-wave velocity anomaly zones.The East Anatolia Fault,associated with the M_(W) 7.8 earthquake,and the SürgüFault,related to the M_(W) 7.5 earthquake,predominantly experienced shear stress.However,their western sections experienced a combination of strike-slip and tensile stresses in addition to shear stress.The ruptures of the M_(W) 7.8 and M_(W) 7.5 earthquakes appear to have bridged a seismic gap that had seen sparse seismicity over the past 200 years prior to the 2023 Turkey earthquake sequence.

Seismicity patterns before the 2021 Fin (Iran) doublet earthquakes using the region-time-length and time-to-failure methods

Knowledge regarding earthquake hazards and seismicity is crucial for crisis management, and the occurrence of foreshocks, seismic activity patterns, and spatiotemporal variations in seismic activity have been studied. Furthermore, the estimation of the region-time-length (RTL) parameter has been proposed to detect seismic quiescence before the occurrence of a large earthquake. In addition, the time-to-failure method has been used to estimate the time occurrence of large earthquakes. Hence, in this study, to gain deeper insight into seismic activity in the southern Zagros region, we utilized the RTL algorithm to identify the quiescence and activation phases leading to the Fin doublet earthquakes. Temporal variations in the RTL parameter showed two significant anomalies. One corresponded to the occurrence time of the first earthquake (2017-12-12);the other anomaly was associated with the occurrence time of the second event (2021-11-14). Based on a negative value of the RTL parameter observed in the vicinity of the Fin epicenters (2021), seismic quiescence (a decrease in seismicity compared to the preceding background rate) was identified. The spatial distribution of the RTL prognostic parameters confirms the appearance of seismic quiescence surrounding the epicenter of the Fin doublet earthquakes (2021). The time-to-failure method was designed using precursory events that describe the acceleration of the seismic energy release before the mainshock. Using the time-to-failure method for the earthquake catalog, it was possible to estimate both the magnitude and time of failure of the Fin doublet. Hence, the time-tofailure technique can be a useful supplementary method to the RTL algorithm for determining the characteristics of impending earthquakes.

Research on the Extraction of OLR Anomaly Prior to Ms 7.5 Sand Point,Alaska Earthquake based on IPI Method

Based on the understanding that the seismic fault system is a nonlinear complex system,Rundle(1995)introduced the nonlinear threshold system used in meteorology to analyze the ocean-atmosphere interface and the El Ni?o Southern Oscillation into the study of seismic activity changes,and then proposed the PI method(Rundle et al.,2000a,b).Wu et al.(2011)modified the Pattern Informatics Method named MPI to extract the ionospheric anomaly by using data from DEMETER satellites which is suitable for 1–3 months short-term prediction.

Myths about Earthquakes:Quo vadis?

We are living in a world of numbers and calculations with enormous amount of pretty fast user-friendly software ready for an automatic output that may lead to a discovery or,alternatively,mislead to a deceptive conclusion,erroneous claims and predictions.As a matter of fact,nowadays,Science can disclose Natural Hazards,assess Risks,and deliver the state-of-the-art Knowledge of looming disaster in advance catastrophes along with useful Recommendations on the level of risks for decision making regarding engineering design,insurance,and emergency management.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study

BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.

Identifying drivers of urban landuse changes in the Wenchuan earthquake- affected area by using night-time light data

To learn the process of urban land evolution before and after an earthquake is vital to formulate the urban reconstruction control policies and recovery measures in the earthquake-stricken areas.However,spatiotemporal evolution and its driving factors of urban land in earthquake-prone areas remains limited due to the scarcity of ground observation data.This research,leveraging night-time light remote sensing imagery and land cover data,conducted a comprehensive analysis of the long-term evolution characteristics of urban land in earthquake-prone areas.It introduced methodologies for assessing the socio-economic impact and the primary natural environmental factors driving urban land evolution in these regions.To validate the proposed methods,the 2008 Wenchuan earthquake-affected area in China was selected as a representative study area.The results indicated that the average Digital Number(DN)values in socio-economically impacted areas showed a trend of rising,falling,and then rising again after the earthquake.DN values in three types of damaged areas including Type Ⅱ,Type Ⅲ,and Type Ⅳ exceeded pre-earthquake levels.The analysis of determinative factors influencing urban land evolution revealed that slope and elevation were key elements in controlling urban land expansion before the earthquake,whereas factors such as slope,elevation,lithology,and faults had a stronger influence on urban land expansion after the earthquake.It can be seen that,in view of the differences in the natural conditions of regions for post-disaster reconstruction,the local government need to actively adjust and adapt to urban spatial planning,so as to leverage the scale effect of large-scale inputs of funds,facilities,human resources and other factors after the disaster,thus enhancing resilience and recovery efficiency in response to disaster impacts.

The 2024 M_(j) 7.6 Noto Peninsula, Japan earthquake caused by the fluid flow in the crust

On January 1, 2024 at 16:10:09 JST, an M_(j) 7.6 earthquake struck the Noto Peninsula in the southern part of the Sea of Japan. This location has been experiencing an earthquake swarm for more than three years. Here, we provide an overview of this earthquake, focusing on the slip distribution of the mainshock and its relationship with the preceding swarm. We also reexamined the source areas of other large earthquakes that occurred around the Sea of Japan in the past and compared them with the Matsushiro earthquake swarm in central Japan from1964 to 1968. The difference between the Matsushiro earthquake swarm and the Noto earthquake swarm is the surrounding stress field. The Matsushiro earthquake swarm was a strike-slip stress field, so the cracks in the crust were oriented vertically. This allowed fluids seeped from the depths to rise and flow out to the surface. On the other hand, the Noto area was a reverse fault stress field. Therefore, the cracks in the earth's crust were oriented horizontally. Fluids flowing underground in deep areas could not rise and spread over a wide area in the horizontal plane. This may have caused a large amount of fluid to accumulate underground, triggering a large earthquake. Although our proposed mechanism does not take into account other complex geological conditions into consideration, it may provide a simple way to explain why the Noto swarm is followed by a large earthquake while other swarms are not.

Stress triggering effect on the 2022 Honghe M_(S)5.0 earthquake with historical strong earthquakes

The 2022 Honghe M_(S)5.0 seismic event is intriguing due to its occurrence in the south of the Red River Fault,an area historically lacking seismic activities greater than M_(S)5.0.To elucidate the seismogenic mechanism and scrutinize stress-triggered interactions,we calculated co-seismic and post-seismic Coulomb stress alterations induced by nine historical seismic events(M≥6.0).The analysis reveals that these substantial seismic events provoked co-seismic stress augmentations of 1.409 bar and postseismic stress increments of 0.159 bar.Noteworthy seismic events,such as the 1833 Songming,1877Shiping,1913 Eshan,and 1970 Tonghai earthquakes,catalyzed the occurrence of the Honghe earthquake.Areas of heightened future seismic risk include the southern region of the Red River Fault and the eastern segments of the Shiping-Jianshui and Qujiang faults.Additionally,we assessed the correlation between the spatial distribution of aftershocks and the Coulomb stress shift triggered by the mainshock,taking into account the influence of calculation parameter settings.

Microearthquake reveals the lithospheric structure at midocean ridges and oceanic transform faults

Mid-ocean ridge and oceanic transforms are among the most prominent features on the seafloor surface and are crucial for understanding seafloor spreading and plate tectonic dynamics,but the deep structure of the oceanic lithosphere remains poorly understood.The large number of microearthquakes occurring along ridges and transforms provide valuable information for gaining an indepth view of the underlying detailed seismic structures,contributing to understanding geodynamic processes within the oceanic lithosphere.Previous studies have indicated that the maximum depth of microseismicity is controlled by the 600-℃isotherm.However,this perspective is being challenged due to increasing observations of deep earthquakes that far exceed this suggested isotherm along mid-ocean ridges and oceanic transform faults.Several mechanisms have been proposed to explain these deep events,and we suggest that local geodynamic processes(e.g.,magma supply,mylonite shear zone,longlived faults,hydrothermal vents,etc.)likely play a more important role than previously thought.

Upper extremity vascular injuries:Etiology,management and outcome

BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.

Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting

BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.