6 February 2023, orthopedic experience in Kahramanmaraş earthquake and surgical decision in patients with crush syndrome

KUNDAKÇI, Buğra; Mirioğlu, Akif; Tekin, Mustafa; Bağır, Melih; Biçer, Ömer Sunkar; Arslan, Yusuf; Özkan, Cenk; Özbarlas, Hilmi Serdar

doi:10.1186/s13018-023-04001-2

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…In these types of injuries, the amputation rates vary between 3% and 58%. [10] In the study by Kundakcı et al, [17] patients with crush extremity injuries affected by the earthquake were examined and a relationship was found between peak CK level and amputation, but no difference was found in terms of the requirement for fasciotomy. In our study, the majority of crush injuries were mostly extremities injuries and 54.5% of the patients underwent procedures such as debridement, fasciotomy, and/or amputation of their extremities.…”

Section: Discussionmentioning

confidence: 99%

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The impact of creatine kinase and base excess on the clinical outcome of crush injuries sustained during the Kahramanmaras/Turkey earthquakes on February 6, 2023

Gur,

Simsek

2024

Medicine

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The aim of the study is to determine the usefulness of base excess (BE) and creatine kinase (CK) in predicting the extent of damage to the extremities, the need for hemodialysis, and the likelihood of mortality in crush injuries. Our study included patients who were affected by the earthquakes that occurred in Kahramanmaras/Turkey on February 6, 2023 and were diagnosed with crush injuries. The study was a retrospective observational study. We used chi-square test, independent sample t test, analysis of variance (ANOVA) to examine whether CK and BE values can be used to predict damage to the extremities, hemodialysis requirement, and mortality. A total of 299 patients were included in the study. A statistically significant relationship was found between BE and extremity damage, hemodialysis requirement, and mortality (P < .005). A statistically significant difference was also seen in terms of extremity damage and hemodialysis requirement with CK (P < .001), while there was no statistically significant difference seen in mortality (P = .204). BE may serve as a predictive biomarker for the development of extremities damage, hemodialysis requirement, and mortality. CK is not predictive of mortality.

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Section: Discussionmentioning

confidence: 99%

“…[20] In crush injuries, the need for hemodialysis is usually temporary and but life-saving. [4,10,11] In a study by Kundakcı et al, [17] it was found that around 50% of patients with crush extremity injuries caused by an earthquake required hemodialysis. In our study, 32.1% of patients with crush injury needed hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

The impact of creatine kinase and base excess on the clinical outcome of crush injuries sustained during the Kahramanmaras/Turkey earthquakes on February 6, 2023

Gur,

Simsek

2024

Medicine

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“…Crush injuries occur as a result of direct trauma to the tissue and compression of the body in one place [ 2 ]. Edema resulting from bleeding and tissue damage may increase intracompartmental pressure, which can cause the development of compartment syndrome [ 16 ]. Compartment syndrome was observed in 38.7% of our patients.…”

Section: Discussionmentioning

confidence: 99%

Earthquake victims in focus: a cross-sectional examination of trauma and management in intensive care unit

Aydin,

Ozel Yesilyurt,

Cetinkaya

et al. 2024

BMC Emerg Med

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Background After the Kahramanmaras earthquake of February 6, 2023, the disaster of the century, a significant number of victims were admitted to intensive care units (ICUs). In this study, we aimed to share the characteristics and management of critical earthquake victims and shed light on our experiences as intensivists in future earthquakes. Methods The study included 62 earthquake victims in two tertiary ICUs. Demographic characteristics, laboratory findings, clinical characteristics, trauma and disease severity scores, treatments administered to patients, and the clinical course of the patients were recorded retrospectively. The patients were divided into two groups, survivors and nonsurvivors, according to 7-day mortality and into two groups according to the duration of their stay under the rubble: those who remained under the rubble for 72 hours or less and those who remained under the rubble for more than 72 hours. A receiver operating characteristic (ROC) curve analysis was used to determine the best cutoff value for the ‘Circulation, Respiration, Abdomen, Motor, and Speech’ (CRAMS) score. Results The median age of the 62 patients included in the study was 35.5 (23-53) years. The median length of stay under the rubble for the patients was 30.5 (12-64.5) hours. The patient was transferred to the ward with a maximum duration of 222 hours under the rubble. The limb (75.8%) was the most common location of trauma in patients admitted to the ICU. Crush syndrome developed in 96.8% of the patients. There was a positive correlation between the development of acute kidney injury (AKI) and myoglobin, serum lactate, and uric acid levels (r = 0.372, p = 0.003; r = 0.307, p = 0.016; r = 0.428, p = 0.001, respectively). The best cutoff of the CRAMS score to predict in-7-day mortality was < 4.5 with 0.94 area under the curve (AUC); application of this threshold resulted in 75% sensitivity and 96.3% specificity. Conclusion Search and rescue operations should continue for at least ten days after an earthquake. The CRAMS score can be used to assess trauma severity and predict mortality in critically ill earthquake victims.

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“…Abrasions and necrotic wounds due to crushing are common. Antiseptics, debridement, and negative pressure wound therapy are the most commonly applied wound care methods ( 7 , 8 ).…”

Section: Case Reportsmentioning

confidence: 99%

Defining Patient Profiles After the 2023 Kahramanmaraş, Turkey Earthquake

Koca

2024

JRM-CC

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Objective: On 6 February 2023, 2 earthquakes with magnitudes of 7.7 and 7.6 mW occurred in Pazarcık and Elbistan districts of Kahramanmaraş province (Turkey) and affected 11 provinces in total, especially Hatay, Malatya, and Adıyaman. Here, we report 3 earthquake victims in order to define patients profiles. Case reports: Three patients who were taken to the orthopedic and neurological rehabilitation program in our inpatient Physical Medicine and Rehabilitation unit after the earthquake are presented. Our first case, a 46-year-old man, remained in the debris for 8.5 h. His left leg was left in the wreckage, and he later developed a drop foot on the left due to compartment syndrome, which developed with pain and swelling in the left calf. There is no fasciotomy procedure. Venous Doppler was reported to be within normal limits. Our second case is a 52-year-old man who was in the debris for 36 h and has a left braxial plexus injury and a left drop foot. He has Buerger’s disease in his medical history. The third case is an 8-year-old girl trapped in rubble during the earthquake with a right orbital fracture and a left foot transmetarsal amputation. She has no neurological signs. Discussion: The patients that apply to our Physical Medicine and Rehabilitation clinic are especially amputees, patients with traumatic brain injury, spinal cord injury, peripheral nerve damage, plexus damage, multiple fractures, joint limitations and soft tissue loss in the musculoskeletal system. After the earthquake, we encountered patients from a wide variety of spectrums in our clinic. In addition to primary musculoskeletal injuries, they also experience systemic problems affecting the musculoskeletal system. Additionally, thrombosis, infection, renal failure, and multiple organ failures may also occur. Conclusion: Countries should develop guidelines for disaster preparedness and establish coordination units that can take quick action, make decisions, and communicate in times of disaster. A good definition of patient clinical profiles after the earthquake will ensure early intervention and prevent permanent disability and functional losses.

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6 February 2023, orthopedic experience in Kahramanmaraş earthquake and surgical decision in patients with crush syndrome

Cited by 21 publications

References 28 publications

The impact of creatine kinase and base excess on the clinical outcome of crush injuries sustained during the Kahramanmaras/Turkey earthquakes on February 6, 2023

The impact of creatine kinase and base excess on the clinical outcome of crush injuries sustained during the Kahramanmaras/Turkey earthquakes on February 6, 2023

Earthquake victims in focus: a cross-sectional examination of trauma and management in intensive care unit

Defining Patient Profiles After the 2023 Kahramanmaraş, Turkey Earthquake

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