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Pediatric Crush Syndrome and Injury Profiles in Earthquake Survivors: A Comprehensive Analysis From the 2023 Turkey
Sefika Aldas1, Murat Ersoy1, Mehtap Durukan Tosun1
1Department of Pediatrics, University of Health Sciences, Mersin City Education and Research Hospital, Mersin, Turkey.
Insights
Pediatric earthquake victims face high rates of crush syndrome and related complications, necessitating specialized trauma protocols. Early detection of risk factors like elevated creatine phosphokinase (CPK) is crucial for preventing severe outcomes such as amputation.
Area of Science:
- Disaster Medicine
- Pediatric Traumatology
- Emergency Medicine
Background:
- Earthquake-related injuries in children present unique clinical challenges.
- Understanding the clinical profiles and hospital stay characteristics of pediatric victims is vital for disaster preparedness.
Purpose of the Study:
- To analyze the clinical outcomes of pediatric victims admitted after an earthquake.
- To identify factors associated with hospital stay and severe complications.
- To improve preparedness and reduce losses in future disaster events.
Main Methods:
- Retrospective analysis of 356 pediatric patients admitted after an earthquake.
- Investigation of demographics, surgical interventions, and life-threatening conditions (crush syndrome, fasciotomy/amputation).
- Calculation of odds ratios (OR) with 95% confidence intervals (CI) for risk factors.
Main Results:
- The most common injury mechanism was entrapment under rubble, affecting lower extremities.
- Crush syndrome occurred in 75.3% of hospitalized patients, with delayed admission increasing risk.
- Elevated creatine phosphokinase (CPK) and myoglobin levels, dehydration, and specific biochemical markers were significantly associated with crush syndrome, fasciotomy, and amputation.
Conclusions:
- Pediatric earthquake victims experience a high burden of crush-related complications.
- Development of pediatric-specific trauma protocols for disaster settings is essential.
- Early identification of risk factors and prompt intervention can mitigate severe outcomes like renal failure and amputation.
Objective:
The clinical profiles of child victims admitted to hospitals following earthquakes, as well as the characteristics associated with hospital stay, are important. This study aimed to analyze the clinical outcomes of pediatric victims admitted following a sudden earthquake to enhance preparedness for accessing essential health services to reduce losses in future disasters.
Methods:
Among 2158 patients referred to the pediatric emergency department (PED), 356 children followed at our tertiary inpatient clinic were included. Demographics, surgical interventions, and the presence of life-threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Crush syndrome was defined as clinical and laboratory evidence of muscle injury accompanied by systemic complications odds ratios (OR) with 95% confidence intervals (CI) were calculated.
Results:
Among the patients, 56.5% were male. The median length of hospital stay was 4 days (range: 1-120). The most common injury mechanism was entrapment under rubble, and the lower extremities were the most frequently affected injury site. Compartment syndrome developed in 31.7% of patients, and 2.8% underwent amputation. Crush syndrome was identified in 75.3% of hospitalized patients and was significantly more common among children admitted on the second day or later after the earthquake. Elevated creatine phosphokinase (CPK) levels significantly increased the likelihood of developing crush syndrome (OR: 61.7, 95% CI) and the need for fasciotomy (OR: 16.9, 95% CI). Fasciotomy was required in 28.9% of patients. Dehydration was associated with an increased risk of fasciotomy (OR: 7.2) and amputation (OR: 5.4). Elevated levels of myoglobin, uric acid, blood urea nitrogen/creatinine, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly associated with crush syndrome and fasciotomy (p < 0.001).
Conclusion:
The high burden of crush-related complications in pediatric earthquake victims underscores the need for pediatric-specific trauma protocols in disaster settings. Early identification of risk factors and rapid intervention may reduce severe outcomes such as fasciotomy, renal failure, and amputation.
