Pediatric crush-related acute kidney injury and risk factors: a single center experience.

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. 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. 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. 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.

Taner S ，Ozdemir U ，Kandemir Gulmez T ，Güven S ，Cicek N ，Kelesoglu E ，Arslan I ，Celik U ... -  《-》

Epidemiological analysis of the victıms wıth crush syndrome in earthquakes of southeastern Turkey.

Ozturk I ，Gungor O ，Ozturk S ，Olmaz R ，Keskin AJG ，Kocyigit I ，Sipahioglu MH ，Dede F ，Ulu S ，Turgutalp K ，Torun D ，Sahutoglu T ，Erdur FM ，Altunoren O ，Danis R ，Yildiz G ，Gurel A ，Horoz M ，Kucuksu M ，Karakose S ，Yildirim T ，Altiparmak MR ，Ayli MD ，Tugcu M ，Eren Z ，Eroglu E ，Yavuz YC ，Akcali E ，Sit D ，Polat M ，Yildirim S ，Alagoz S ，Bek SG ，Pembegul I ，Karaaslan T ，Keles M ，Sari F ，Yilmaz U ，Gorgulu N ，Sahin G ，Aydin Z ，Yadigar S ，Ulutas O ，Selcuk NY ，Ayar Y ，Turgut D ，Oto OA ，Koc M ，Yıldız A ，Tuglular S ，Sever MS ... -  《-》

A new score predicting renal replacement therapy in patients with crush injuries: Analysis of a major earthquake.

It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT. This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction. Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09-4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04-0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00-1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT. The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.

Comoglu M ，Acehan F ，Inan O ，Demir BF ，Yılmaz Y ，Sahiner ES ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》

Crush injuries to the lower limbs at a major UK trauma centre: a retrospective observational study.

Crush injuries result from the physical compression of muscles and may lead to crush syndrome. Early fluid resuscitation and surgical intervention is key. Few studies have reported the outcomes of crush injuries in the non-disaster setting. This retrospective study aims to characterise such cases. Patients with lower limb crush injuries were identified from an internal database. Non-crush injuries and patients under the age of 18 were excluded. Types of injuries, management, and complications were extracted. 27 patients were included. The right leg (n = 10) was the most frequently injured site. Mechanisms included being run over by vehicles (n = 10) and being crushed by, between, or inside vehicles (n = 8). Fractures were the most common acute injuries (n = 16), while other injuries included rhabdomyolysis, compartment syndrome and degloving. Fluid resuscitation was required in 17 patients. 58 surgeries were performed on 18 patients, with wound debridement and amputations being common. Complications such as acute kidney injury, hyperkalaemia, and sepsis were noted during hospitalisation. Individuals with injuries to the leg or thigh experienced a greater burden of injury and incidence of in-hospital complications compared to those with isolated injuries to the foot. Crush injuries in the non-disaster setting show distinct mechanisms and injury patterns. Those with crush injuries to the leg or thigh more closely resemble a patient cohort seen in the disaster setting compared to those with isolated foot injuries.

Rama E ，Jayawant S ，Zhang J ，Krkovic M ... -  《-》