Enhancing Triage and Management in Earthquake-Related Injuries: The SAFE-QUAKE Scoring System for Predicting Dialysis Requirements

Abstract

Objectives: Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis. Methods: A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis. Results: The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%. Conclusions: The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.

START-A (Simple Triage, Rapid Treatment and Analgesia) in Mass Casualty Incidents

“…4 More recent triage tools, such as the Ten Second Triage, address this concern with an emphasis on hemorrhage control in the second step of the triage algorithm, suggesting the use of "pressure, tourniquet, and packing." 5 Implementing simple analgesia at the end of a triage tool, as suggested by Dr Yilmaz et al through the acronym START-A (simple triage, rapid treatment, and analgesia), could allow for early analgesia, with limited additional time added to triage. The therapeutic options suggested in our article, such as fentanyl lozenges and methoxyflurane inhalers, take only a few seconds to be delivered, avoiding the time-consuming task of intravenous cannula insertion and medication titration.…”

“…4 The studies specifically investigated the use of START and the subsequently proposed Secondary Assessment of Victim Endpoint (SAVE) algorithms in managing MCIs stemming from natural disasters such as earthquakes, with additional recommendations for these protocols being put forward. 5 Similarly, Benson and colleagues argued that MCIs could be successfully managed by sequentially using the START and SAVE algorithms. The sequential application of these algorithms during the devastating earthquake was observed to yield more favorable outcomes.…”

Simplified and Preliminary Assessment for Dialysis Requirement in Earthquake Patients

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To the Editor, The article by Yılmaz, et al is very enlightening. 1 The study used entrapment duration, pH levels, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase-toalanine transaminase (AST-to-ALT) ratio as key predictors of dialysis requirements in identifying high-risk patients with acute kidney injury (AKI) who require dialysis.Of the predictors in the study, except for the entrapment duration, acquiring these data at disaster sites is challenging and requires assessment at a medical facility. However, prehospital preliminary assessments are important to enable more targeted referrals for patients requiring dialysis.

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“…To the Editor, The article by Yılmaz, et al is very enlightening. 1 The study used entrapment duration, pH levels, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase-toalanine transaminase (AST-to-ALT) ratio as key predictors of dialysis requirements in identifying high-risk patients with acute kidney injury (AKI) who require dialysis.…”