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Crush Injuries and Outcomes in the 2023 Kahramanmaraş, Türkiye Earthquake: A Referral Center Experience
Ayşen Durak Aslan1, Ömer Tayyip Özen2, Hacer Uçmak1
1Department of Pediatric Critical Care, Ankara University School of Medicine, Ankara, Turkey.
Insights
Pediatric trauma care faced challenges after the 2023 Kahramanmaras earthquakes. A disaster response plan and multidisciplinary care improved outcomes for crush injuries and acute kidney injury in pediatric patients.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Disaster Medicine
Background:
- The 2023 Kahramanmaras earthquakes presented significant challenges for managing pediatric trauma patients in Turkey.
- Healthcare facilities, including referral centers, had to adapt rapidly to a surge in complex injuries, particularly crush-related trauma.
Purpose of the Study:
- To describe the management of complex pediatric trauma cases, focusing on crush-related injuries, following the 2023 earthquakes.
- To discuss patient outcomes and the organizational strategies employed by a large referral center.
Main Methods:
- Retrospective analysis of data from pediatric patients admitted to a tertiary pediatric intensive care unit.
- Data extraction from electronic medical records, including demographics, injury patterns, management, and outcomes.
Main Results:
- Twenty-nine pediatric patients (median age 10.3 years) were analyzed.
- High incidence of compartment syndrome (93.1%) requiring fasciotomies (77.8%), crush syndrome (82.8%), and acute kidney injury requiring kidney replacement therapy (58.3%).
- Effective disaster response, multidisciplinary management, and early intervention were crucial for optimizing outcomes.
Conclusions:
- Crush syndrome, compartment syndrome, and acute kidney injuries were the primary complications in pediatric earthquake survivors.
- A well-executed disaster response plan was instrumental in achieving favorable outcomes.
Aim:
Turkish healthcare staff faced significant challenges managing paediatric trauma patients after the major 2023 Kahramanmaras earthquakes, which killed more than 50 000 people. We describe how our large referral centre treated complex cases, particularly crush-related injuries, and discuss both outcomes and hospital organisation.
Methods:
This study retrospectively analysed data from paediatric patients who were admitted to our tertiary paediatric intensive care unit at Ankara University Faculty of Medicine Children's Hospital, which was 595 km from the epicentre of the earthquake. Patient data, including demographics, injury patterns, management strategies, and outcomes were extracted from electronic medical records.
Results:
The 29 patients (62.1% female) had a median age of 10.3 (range 2-17) years. Compartment syndrome occurred in 93.1% of the patients, and 77.8% of these underwent fasciotomies. Amputations, without prior fasciotomies, were performed in three cases. Crush syndrome developed in 82.8% of the patients, and 58.3% underwent kidney replacement therapy. None of the patients required long-term haemodialysis. An effective disaster response plan, multidisciplinary management, and early intervention were essential factors in optimising outcomes.
Conclusion:
Crush syndrome, compartment syndrome, and acute kidney injuries were the most common complications after the earthquake, and our well-executed disaster response plan optimised outcomes.
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