Abstract
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 11.62years) were evaluated. Mean TUR was 13h (interquartile range 32.5, max 240h). Thirty-one of 32 patients with a TUR of >120h survived. The patient who was rescued after 10days survived. Two-thirds of the patients were given 50mEq/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 2000-3000mL/m2 body surface area (BSA), 40% at 3000-4000mL/m2 BSA and only 2% at >4000mL/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 >15years, creatine phosphokinase (CK) ≥20950U/L, TUR ≥10h and the first-day IVF volume <3000-4000mL/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 4days of admission. All patients admitted after 7days 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 >20950U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000mL/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 10days.
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