Unveiling the Natural History of Category 4 Tropical Cyclones: The Puerto Rico Trauma Hospital Experience after Hurricane Maria.
OBJECTIVES The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period. METHODS Admissions from September 20, 2017, through January 20, 2018, constituted the post Maria period (473 patients) the corresponding months of the previous year comprised the pre Maria period (439 patients) Comparisons were done using Pearson's chi square or Mann Whitney U tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period. RESULTS Postlandfall admissions among patients aged 40 64 y increased by 6.6% while among subjects between ages 18 and 39 y dropped by 7.0% (P 0.03) Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P 0.05) and the frequency of Glasgow Coma Scale scores =8 (17.1% vs 10.9% P 0.03) were higher among poststorm patients. Moreover, a 2 fold (odds ratio 1.93; 95% CI: 1.07 3.47) increase in mortality was observed after Maria, when adjusting for covariates. CONCLUSIONS Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2 fold increased mortality risk.
Disaster medicine and public health preparedness