Crush Syndrome of Children in Kahramanmaraş Earthquake: A Single Center Experience in Malatya
Şenay Zırhlı Selçuk1, Ahmet Taner Elmas1, Yılmaz Tabel1
1Department of Pediatric Nephrology, University of İnönü, Malatya, Turkey.
Insights
Pediatric crush syndrome (CS) management during disasters is critical. Delayed rescue up to 81 hours, coupled with cold weather, may prevent CS development in children, highlighting the importance of rescue patience.
Area of Science:
- Disaster Medicine
- Pediatric Emergency Medicine
- Trauma Surgery
Background:
- Children are highly vulnerable to natural disasters, facing severe consequences.
- Crush syndrome (CS) is a significant secondary cause of death after direct injury in disaster settings.
- Effective management of pediatric CS is crucial for improving outcomes.
Purpose of the Study:
- To evaluate clinical and laboratory outcomes of pediatric patients with crush syndrome (CS) following a disaster.
- To share experiences in managing children with CS during mass casualty events.
- To identify determinants for CS development and the need for interventions like dialysis or amputation.
Main Methods:
- Retrospective assessment of 26 pediatric patients admitted after an earthquake.
- Analysis of age, weight, time under rubble, crush injury characteristics, and laboratory results.
- Establishment of diagnostic criteria for CS and evaluation of treatment needs.
Main Results:
- Crush syndrome (CS) was diagnosed in 10 of 26 pediatric patients.
- Significant differences in laboratory markers (creatinine, AST, ALT, CK, Hct, pH, HCO3, myoglobin) were noted between CS and non-CS groups.
- No CS symptoms were observed in children rescued within 6 hours; those developing CS were rescued within 48 hours.
Conclusions:
- Extended rescue times (up to 81 hours) without CS development underscore the importance of prolonged rescue efforts.
- Cold weather conditions may have mitigated dehydration and acute kidney injury, potentially reducing CS incidence.
- Patience and environmental factors play a role in preventing CS in pediatric disaster victims.
Objective:
Natural disasters cause enormous environmental, economic, and human losses. Children are the most vulnerable group and face severe consequences. While the primary cause of post-traumatic death is direct injury, the secondary cause is crush syndrome (CS). In this study, we aimed to share our experience in the management of children with CS during disasters by evaluating the clinical and laboratory outcomes of a group of 26 paediatric patients.
Materials And Methods:
Age, weight, length of time under rubble, laboratory results, and characteristics of crush injuries were assessed in 26 paediatric patients admitted to the emergency department after the earthquake. Diagnostic criteria for CS were established and the need for dialysis, hyperbaric oxygen or amputation and its determinants were assessed.
Results:
Crush syndrome was observed in 10 of the 26 patients. Significant differences in creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, hematocrit, pH, HCO3, and myoglobin levels were observed between patients with and without CS. None of the individuals rescued from the rubble within the first 6 hours had symptoms associated with CS. These 10 patients who developed CS were rescued within the first 48 hours of the earthquake, while 2 siblings were rescued after 81 hours and did not develop CS.
Conclusion:
The fact that the children were rescued from the rubble after 81 hours without developing CS shows the importance of patience in rescue operations. In addition, the very cold weather conditions during this earthquake may have prevented the development of dehydration and acute kidney injury and reduced the possibility of CS.
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