Pediatric Crush Syndrome and Injury Profiles in Earthquake Survivors: A Comprehensive Analysis From the 2023 Turkey Earthquake.

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.