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Pediatric crush-related acute kidney injury and risk factors: a single center experience
Sevgin Taner1, Ulas Ozdemir2, Tugba Kandemir Gulmez3
1Adana City Training and Research Hospital, Pediatric Nephrology, Adana, Turkey. sevgintaner@gmail.com.
Insights
Earthquake survivors with crush injuries face high risks of crush syndrome and acute kidney injury (AKI). Older children with crush syndrome, abdominal trauma, and advanced age are at greater risk for severe AKI.
Area of Science:
- Disaster medicine
- Pediatric trauma care
- Nephrology
Background:
- Crush injury is a significant complication in earthquake victims, often leading to crush syndrome and acute kidney injury (AKI).
- Crush syndrome and AKI are leading causes of in-hospital mortality following earthquakes.
- This study analyzes experiences from the Turkey-Syria earthquake to identify risk factors for these conditions.
Purpose of the Study:
- To report on the experience of managing pediatric crush injuries after the Turkey-Syria earthquake.
- To identify risk factors associated with the development of crush syndrome and crush-related AKI in pediatric earthquake survivors.
Main Methods:
- Retrospective analysis of demographic, laboratory, and clinical data.
- Inclusion of 1134 children admitted to the emergency department, with a focus on 265 diagnosed with crush injury.
Main Results:
- Crush syndrome developed in 50.9% of pediatric patients, with older, heavier children being more susceptible.
- Acute kidney injury (AKI) was observed in 59.2% of cases, with 12.1% requiring kidney replacement therapy (KRT).
- Risk factors for AKI Stage 3 included crush syndrome, abdominal trauma, and older age.
Conclusions:
- The study underscores the need for a pre-established national emergency disaster plan.
- Close monitoring for AKI is crucial in older pediatric earthquake victims with severe crush syndrome and multiple traumas.
- Timely medical intervention, including fluid resuscitation and dialysis, is essential for managing crush-related AKI.
Background And Objectives:
Crush injury, the most important trauma complication encountered in earthquake victims, occurs as a result of prolonged compression of muscle mass. Crush syndrome, resulting from crush injury, and acute kidney injury (AKI) are the most common causes of in-hospital deaths after earthquakes. The aim of this study is to convey our experience after the devastating Turkey-Syria earthquake and to identify the risk factors of crush syndrome and crush-related AKI.
Methods:
Of the 1134 children admitted to the emergency department, 265 with crush injury were included the study. Demographic information, laboratory and clinical data of the patients were retrospectively analyzed.
Results:
Mean age of the patients was 10.3 ± 4.9 years (134 females and 131 males). The median time spent under the rubble was 20 h. Crush syndrome developed in 135 (50.9%). Patients with crush syndrome were older and had higher body weight, respectively (p = 0.014, p = 0.044). Acute kidney injury was present in 157 (59.2%) patients. Thirty-two patients (12.1%) received kidney replacement therapy (KRT). The risk factors for the development of AKI Stage 3 were crush syndrome, abdominal trauma, and age.
Conclusion:
This disaster taught us the importance of establishing in advance a national emergency disaster plan. Older pediatric earthquake victims with multiple trauma and severe crush syndrome should be closely followed-up for development of AKI and, if necessary, started on dialysis. Timely access to medical care, early fluid resuscitation, and effective use of dialysis treatment are essential.
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