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Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey earthquake
S H Iskit1, H Alpay, H Tuğtepe
1Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Insights
Pediatric trauma patients from the 1999 Marmara earthquake frequently developed crush injury and crush syndrome, leading to acute renal failure. Close monitoring of children with crush injuries is crucial for early detection and management of acute renal failure.
Area of Science:
- Disaster medicine
- Pediatric trauma care
- Nephrology
Background:
- The 1999 Marmara earthquake caused widespread devastation, impacting numerous buildings and resulting in significant casualties.
- Previous disaster reports have overlooked pediatric trauma, necessitating a focused analysis of this demographic.
Purpose of the Study:
- To analyze clinical and laboratory data of pediatric trauma patients following the 1999 Marmara earthquake.
- To identify patterns and complications in children affected by the earthquake.
Main Methods:
- Retrospective review of medical records for 33 injured children (14 days to 16 years).
- Data collected included time under rubble, injury type, treatment, complications, and development of acute renal failure (ARF).
- Standard treatment for ARF and conservative management for crush injuries were employed.
Main Results:
- Crush injury (CI) was prevalent, with 10 of 15 cases developing ARF upon admission.
- Elevated creatinine levels were observed in all ARF cases; hyperkalemia was less common.
- Mean serum creatinine kinase (CK) in crush syndrome (CS) cases was 6,040 U/L; no significant predictors for CS development were identified.
Conclusions:
- Crush injury and crush syndrome were common among pediatric earthquake survivors.
- The high incidence of ARF underscores the need for specialized medical management of pediatric trauma victims during rescue operations.
- Close observation of children with CI is recommended for early ARF detection, as clinical and laboratory findings were not predictive.
Background/Purpose:
The Marmara earthquake, which destroyed more than 150,000 buildings and caused 15,000 deaths and 40,000 casualties, resembled the Hanshin-Awaji earthquake in many respects. Previous reports from similar disasters from several centres have not addressed trauma in the pediatric age group. The aim of this study was to analyze the clinical and laboratory data of pediatric trauma patients referred to a tertiary center after the 1999 Marmara earthquake.
Methods:
The medical records of 33 injured children, aged from 14 days to 16 years, were reviewed retrospectively. The time spent buried under rubble, type of injury, treatment given, complications, laboratory data, and development of acute renal failure (ARF) were noted. Patients in whom ARF developed were treated with a standard regimen of fluid replacement, alkalinization, and diuretics. Limbs with crush injuries were managed as conservatively as possible.
Results:
All except 3 cases were evacuated from under the debris of collapsed buildings after 1 to 110 (mean, 30.04 +/- 6.48) hours. Seventy-eight percent were transported to our center within the first 3 days. Crush injury (CI) was present in 15 cases, and in 10 of them ARF had already developed by admission. Although serum levels of creatinine were elevated (1.2 to 5 mg/dL) in all cases with ARF, hyperkalemia was observed in only 4. The mean serum creatinine kinase (CK) level of cases with crush syndrome (CS) was 6,040 +/- 4,158 U/L. No significant correlations were detected between the development of CS, age, the time spent under the rubble, the time before admission, or the number of crushed extremities.
Conclusions:
CI and CS were the most common entities encountered among our pediatric patients after the 1999 Marmara earthquake. The high incidence of ARF indicates the importance of medical management of this age group during rescue. Because neither laboratory data nor clinical findings predicted CS in our patients, we recommend close observation and monitoring of children with CI for the development of ARF.