First-Week Analysis after the Turkey Earthquakes: Demographic and Clinical Outcomes of Victims.

During a major earthquake, escape attempts or collapsed buildings can result in injury, disability, and even death for victims. The aim of this study is to examine the demographic characteristics, clinical outcomes, and injuries of victims admitted to the emergency department within the first week after an earthquake. This is a retrospective observational study conducted on earthquake victims who were admitted to the emergency services of a tertiary medical faculty and a training and research hospital in the city of Diyarbakir, located in the Southeastern Anatolia Region of Turkey, from February 6 through February 12, 2023. Of the eligible 662 earthquake victims, the mean age was 10.66 (SD = 4.78 [min 0, max 17]) in children, 36.87 (SD = 4.78 [min 18, max 63]) in adults, and 72.85 (SD = 5.83 [min 65, max 84]) in the elderly. Women constituted 52.8% of the victims, 19.7% were children, and 8.0% were elderly. Sixty-one percent (61.0%) of earthquake victims were admitted to emergency services in the first three days following the disaster; 37.7% of all victims were transferred from other affected cities to Diyarbakır. In all, 80.2% of the victims were admitted as survivors to the emergency services (36.8% were rescued under rubble, 40.1% with injuries while attempting to escape the earthquake, and 3.3% with nontraumatic reasons) and 19.8% were deceased under rubble. The majority of the 131 deceased victims were women (52.7%), 20.6% were children, and 7.6% were elderly. An estimated 38.3% of victims were hospitalized (20.9% in the ward and 17.4% in the intensive care unit [ICU]). For all age groups that survived under the rubble, the extremities were most injured (53.6% for children, 53.1% for adults, and 55.5% for the elderly). Of adult survivors, 26.6% needed only fluid therapy, renal replacement treatment (hemodialysis) was required 20.7%, and 11.8% required amputation. Of children survivors under the rubble, renal replacement treatment (hemodialysis) was required for only four, seven required amputation, and 12 needed only fluid resuscitation for crush injury. Of elderly survivors, two needed only fluid therapy, renal replacement treatment (hemodialysis) was required for two, and no amputation was required. Six patients survived under the rubble and died in the ICU. The definition of the demographic characteristics and clinical outcomes of earthquake patients is critical to the development of preparedness, response, and recovery policies for future disasters.

Sarı H ，Özel M ，Akkoç MF ，Şen A ... -  《-》

Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaraş (Turkey) Earthquake.

Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaraş (Turkey) earthquakes. This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6 through February 20, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

Buyurgan ÇS ，Bozkurt Babuş S ，Yarkaç A ，Köse A ，Usluer HO ，Ayrık C ，Narcı H ，Orekici Temel G ... -  《-》

Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue.

Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaraş earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment. Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT. •Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately. •CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement.

Atmis B ，Bayazit AK ，Cagli Piskin C ，Saribas E ，Piskin FC ，Bilen S ，Ozgur Horoz O ，Ekinci F ，Turker I ，Telefon HA ，Unal I ，Yilmaz HL ，Narli N ，Yildizdas D ... -  《-》

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maraş, Turkey earthquakes.

On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2-60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

Akın M ，Tuncer HB ，Yastı AÇ 《-》

Pediatric kidney care experience after the 2023 Türkiye earthquake.

Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Bakkaloğlu SA ，Delibaş A ，Sürmeli Döven S ，Taner S ，Yavuz S ，Erfidan G ，Danacı Vatansever E ，Aynacı F ，Yilmaz K ，Taşdemir M ，Akacı O ，Akıncı N ，Güven S ，Çiçek N ，Dursun I ，Keleşoğlu E ，Sancaktar M ，Alaygut D ，Saygılı S ，Yavaşcan Ö ，Yılmaz A ，Gülleroğlu K ，Ertan P ，Demir BK ，Poyrazoğlu H ，Pınarbaşı S ，Gençler A ，Baştuğ F ，Günay N ，Çeleğen K ，Noyan A ，Parmaksız G ，Avcı B ，Çaycı FŞ ，Bayrakçı U ，Özlü SG ，Aksoy ÖY ，Yel S ，İnal GA ，Köse S ，Bayazıt AK ，Atmış B ，Sarıbaş E ，Çağlı Ç ，Tabel Y ，Elmas AT ，Zırhlı Selçuk Ş ，Demircioğlu Kılıç B ，Akbalık Kara M ，Büyükçelik M ，Balat A ，Durucu Tiryaki B ，Erdoğdu B ，Aksu B ，Mahmudova G ，Dursun H ，Candan C ，Göknar N ，Mutlubaş F ，Çamlar SA ，Başaran C ，Akbulut BB ，Düzova A ，Gülhan B ，Oruç Ç ，Peru H ，Alpay H ，Türkkan ÖN ，Gülmez R ，Çelakıl M ，Doğan K ，Bilge I ，Pehlivanoğlu C ，Büyükkaragöz B ，Leventoğlu E ，Alpman N ，Zeybek C ，Tülpar S ，Çiçek Gülşan RY ，Kara A ，Gürgöze MK ，Akyol Önder EN ，Özdemir Atikel Y ，Pul S ，Sönmez F ，Yıldız G ，Akman S ，Elmacı M ，Küçük N ，Yüksel S ，Kavaz A ，Nalçacıoğlu H ，Alparslan C ，Dinçel N ，Elhan AH ，Sever L ... -  《-》