Incidence and outcomes of dysnatremia in crush injury patients admitted to Türkiye's largest hospital following the Kahramanmaraş earthquake.

Dysnatremia is a critical electrolyte disturbance that can significantly impact the prognosis of trauma patients by influencing fluid balance, neurological function, and hemodynamics. Although sodium disorder is common in hospitalized patients, few studies have specifically examined the incidence of dysnatremia in patients presenting to the emergency department for post-earthquake trauma. The aim of this study is to evaluate the incidence of dysnatremia and the prognosis of patients with dysnatremia in trauma patients admitted to our center after the Kahramanmaraş earthquake. Between February 6th, 2023 and February 20th, 2023, a total of 422 patients with earthquake-related crush injuries after the Kahramanmaras earthquake were retrospectively analyzed. Patients were divided into two groups: the survivor group and the exitus group. Then, patients with dysnatremia were evaluated. Age, gender, the city where patients came from, type of presentation, injured organ systems and extremities, laboratory findings, ward admission, intensive care admission, GCS, MESS, ISS, RTS, TRISS, and hemodialysis sessions were analyzed. A total of 422 earthquake victims with crush injuries were included in the study. Dysnatremia was present in 28% of the patients, and these patients had a longer hospital stay. GCS was lower, MESS and ISS values were higher, and survival rates according to TRISS were lower. Multiple extremity trauma, crush syndrome, and dialysis rates were more common in the dysnatremia group. Additionally, fasciotomy, amputation and mortality rates were higher in the dysnatremia group. Dysnatremia is a common finding in patients with crush injuries and is associated with more severe trauma and poorer clinical outcomes. This study highlights the need for close monitoring and management of sodium disturbances in trauma patients, not only in the context of earthquakes but across various disaster scenarios. Recognizing and addressing dysnatremia can contribute to improved patient outcomes in disaster and emergency settings.

Yazla M ，Aksoy FM 《BMC EMERGENCY MEDICINE》

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 ... -  《-》

Predictive factors for acute kidney injury and amputation in crush injuries from the Kahramanmaraş earthquakes.

Köroğlu M ，Karakaplan M ，Barakat M ，Ergen E ，Aslantürk O ，Özdeş HU ，Bıçakcıoğlu M ，Yaşar Ş ... -  《-》

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 ... -  《-》

Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes.

The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. The demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. Twenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.

Bicakcioglu M ，Gok A ，Cicek IB ，Dogan Z ，Ozer AB ... -  《-》