Diagnostic evaluation of hematologic inflammatory markers for earthquake-related crush syndrome in pediatric patients
Fatma Durak1, Özlem Tezol1, Gülçin Bozlu2
1Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey.
Insights
Hematologic inflammatory markers can help diagnose crush syndrome in children after disasters. Elevated markers like neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) indicate crush syndrome, aiding rapid emergency treatment.
Area of Science:
- Emergency Medicine
- Pediatric Traumatology
- Disaster Medicine
Background:
- Early diagnosis of crush syndrome is critical in mass casualty incidents to ensure timely treatment.
- Pediatric patients injured in disasters, such as the 2023 Turkey-Syria earthquake, require specific diagnostic tools.
- Existing diagnostic methods may not be sufficient for rapid assessment in emergency settings.
Purpose of the Study:
- To evaluate the utility of hematologic inflammatory markers as early diagnostic indicators for crush syndrome in pediatric earthquake survivors.
- To differentiate between trauma, crush injury, and crush syndrome using these markers.
Main Methods:
- An analytical study involving 123 pediatric patients trapped under debris.
- Classification into trauma (normal CK), crush injury, and crush syndrome groups based on creatine kinase (CK) levels and clinical presentation.
- Calculation and analysis of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI) from complete blood count data.
Main Results:
- Significantly higher median values for NLR, MLR, SII, SIRI, and AISI were observed in the crush syndrome group compared to trauma and crush injury groups (p < 0.001).
- Receiver operating characteristic (ROC) curve analysis demonstrated good discriminatory power for NLR (AUC=0.75), MLR (AUC=0.72), SII (AUC=0.73), SIRI (AUC=0.75), and AISI (AUC=0.72) in identifying crush syndrome.
- PLR also showed some diagnostic utility (AUC=0.63).
Conclusions:
- Hematologic inflammatory markers, particularly NLR and SII, show promise as rapid diagnostic aids for crush syndrome in pediatric disaster victims.
- These markers can assist emergency department clinicians in making timely treatment decisions.
- Further validation in diverse disaster scenarios is warranted.
Background:
In order to ensure the early treatment of crush syndrome in emergency departments in times of disaster, there is a need for tools that will accelerate and facilitate the diagnosis. We aimed to assess hematologic inflammatory markers as potential diagnostic indicators of crush syndrome in pediatric patients injured by being trapped under debris in the 2023 Turkey-Syria earthquake.
Methods:
This analytical study included 123 pediatric cases with a history of being under debris. Patients were divided into three groups according to serum creatine kinase (CK) values and clinical characteristics at the time of admission: trauma group with a normal CK level (n = 33), crush injury group (n = 30), and crush syndrome group (n = 64). Complete blood count results sent at the time of presentation to the emergency department were analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and the aggregate index of systemic inflammation (AISI) were calculated.
Results:
The median NLR, MLR, SII, SIRI, and AISI were significantly higher in the crush syndrome group compared to both the normal CK and crush injury groups (p < 0.001). According to receiver operating characteristic curve analysis performed for distinguishing between patients with and without crush syndrome, the area under curves of NLR, MLR, PLR, SII, SIRI, and AISI were 0.75, 0.72, 0.63, 0.73, 0.75, and 0.72, respectively.
Conclusions:
The use of hematologic inflammatory markers may assist clinicians in making rapid decisions regarding the diagnosis and treatment of crush syndrome in the event of a disaster.
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