Disaster of the Century, 2023 Earthquake of Turkey: How Can We Prevent Amputation of Children

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It is extremely important to determine the clinical profile of vulnerable child victims admitted in emergencies and the characteristics that are associated with the hospital stay. Therefore, we aimed to analyze the experiences of children admitted to a tertiary hospital to improve future preparedness in case of a sudden disaster. Methods A total of 356 children who were referred from the pediatric emergency department (PED) were included in the study. All patients were subjected to medical history, vital signs, state of hydration, pulse oximetry, physical examination, and routine laboratory tests. Chest X-ray, abdominal ultrasound, and Computed tomography were also documented. Demographics and physical examination findings, duration of hospitalization, surgical interventions, concomitant complications, and presence of life-threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Medications and additional treatments like hemodialysis, and hyperbaric oxygen and the outcomes were also recorded. Results Of the patients, 56.5% were male and median age was 132 months. There was no statistical significance regarding the effect of age and gender on parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and need for PICU. Injuries such as falling objects/slipping were more common in boys (P < 0.05). Of the children, only 11.2% were admitted in the first 24 hours and 44.7% were admitted on the third day. 11.8% (n:42) had signs of dehydration, 15.2% had hypothermia and 7% had hypotension/shock. Crush was noted in 41 dehydrated patients, 53 patients having hypothermia, and 24 patients with hypotension/shock. The average length of hospital stay was 6.7 days. The most common injury was being trapped under rubble with 80.3% and the most common injury site was lower extremities at 60.4%. Compartment syndrome developed in 31.7% of the patients, bone fractures were detected in 34.3% of the patients and 2.8% (n:10) of the patients were amputated. Crush syndrome was detected in 75.3% of the patients, and the incidence was higher in patients admitted on the second day or later and the requirement of fasciotomy increased. Elevated creatine phosphokinase (CPK), increased crush injury 61 times and fasciotomy by 16.8 times, Also, elevation of Myoglobin and Uric acid levels were higher in patients with crush injury (P = 0.005). Of patients with crush syndrome, 28.9% (n:103) required/underwent fasciotomy due to compartment syndrome, and a significant relationship was found between crush injury and the need for fasciotomy (P < 0.001). The likelihood of fasciotomy was 26 times higher in crush injury. There was a strong relationship between dehydration and the development of crush injury and the need for fasciotomy (P < 0.001). Anemia, elevated uric acid, BUN and Creatin, and AST/ALT levels and development of crush syndrome and the need for fasciotomy/amputation were higher (P < 0.001). Conclusion Dehydration, and hypotension/shock were related to crush injury and fasciotomy. Compartment syndrome and bone fractures may develop in one-third of the children. Anemia and elevated biochemical laboratory parameters must be followed and elevated CPK, myoglobin, and uric acid levels are highly associated with fasciotomy and amputation. Therefore, for the development of preparedness, response, and recovery policies for future disasters the clinical outcomes of children are crucial and treatments like fasciotomy, hyperbaric oxygen, and hemodialysis/plasmapheresis must be administered timely to prevent amputation and development of sequelae. amputation child crush syndrome disaster earthquake fasciotomy pediatric emergency care INTRODUCTION Large scale, sudden-onset natural disasters occur unexpectedly which disturb the normal order of life beyond the adaptive capabilities causing widespread destruction and resulting in high numbers of injuries, disabilities, and death. In addition, it paralyzes the local health care system and social welfare institutions, resulting in morbidity and mortality and giving rise to critical requirements for external aid and urgent external assistance ( 1 , 2 ). Formerly earthquakes hit countries such as; Guatemala (23,000 deaths), Southern Italy (2,735 deaths), Armenia (24,944 deaths), the Philippines (1,600 deaths), Iran (32,500 deaths), India (9,475 deaths), Japan (6,308 deaths), Russia (1,989 deaths) and China (322 deaths), Taiwan (2,100 deaths), Iran (30,000 deaths) leading to large number of people being homeless ( 3 ). An earthquake with a Richter scale magnitude of 7.7 occurred on February 2023, at 04:17 am, first lasting for 80 seconds, with 3 consecutive catastrophic shocks. The epicenter was located on Kahramanmaras which is on the eastern Anatolia fault line surrounding a densely populated region of 11 provinces. Approximately 14 million people live in the provinces affected by the earthquake, and the number constitutes approximately 13.4% of Turkey's population. Of the child population in our country, 21.3% live in regions affected by the earthquake. The origin was approximately seven kilometers deep, the surface area of the earthquake zone was 13.9 thousand km² and the area constituted approximately 17.8% of Turkey. The second earthquake with a magnitude of 7.6 occurred 9 hours later and caused much greater effect causing the debris fields to collapse further and resulting in the buildings to collapse which were not damaged in the first earthquake. Within hours, the government made an official request for international assistance and a Level 3 emergency was pronounced by the director of the World Health Organization (WHO) after the earthquakes. The Turkish Ministry of Interior Disaster and Emergency Management Presidency (AFAD) released an official announcement informing the public that 2,724 aftershocks occurred in the first week following the earthquake. As of May 2023, the earthquake had killed at least 50,783 people and injured an additional 158,165 people, and more than 202,000 buildings were announced to be demolished or heavily damaged ( 4 , 5 ). During the earthquake, people were asleep in homes, and they couldn’t get out, escape, or seek for care. Many children had lost their homes and loved ones and faced the predicament of the lack of schools and medical treatment. Accordingly, thousands of buildings collapsed and many people were trapped under the rubble. They could not be rescued within hours to days of the initial earthquake. Additionally, due to the hurry to provide emergency care, victims were separated from their families, some of whom were taken to the nearest health organization. Moreover, the earthquake also damaged hospitals in the region, forcing victims to go to other cities’ hospitals far away ( 5 ). It is extremely important to define the clinical profile of earthquake victims admitted in emergency situations and to determine the characteristics of children who are one of the most vulnerable and affected populations of the community. Providing emergency trauma treatment and critical medicines, emergency kits, and supplies to meet urgent requirements, especially among children is very important including post-traumatic rehabilitation for the injured ones. The literature lacks evidence about characteristics, and clinical outcomes among children victims regarding emergency health services. Therefore, we aimed to analyze the experiences and clinical outcomes of children admitted to a tertiary research hospital after the earthquake, to improve future preparedness associated with access to essential health services, and to strengthen the emergency response system and the strategy for diminishing amputation/sequelae in case of a future disaster setting. Methods After approval from the Ethical Committee of Toros University with registration number DEISC-PR-26.04.2023/46, all admissions of earthquake victims from 6 February to 6 March 2023 were analyzed consecutively in concordance with the Helsinki Declaration. The pediatric inpatient clinic is a 90-bed, multidisciplinary, tertiary referral and trauma center for infants and children. A total of 356 children between the ages of 1 month and 18 years, who came from affected 11 provinces and were referred from the pediatric emergency department (PED) of the hospital were scanned from the hospital database system and included in the study. Earthquake victims were defined as children admitted with a clinical condition directly related to the earthquake. All patients were subjected to medical history, vital signs, state of hydration, behavioral state, pulse oximetry, physical examination, and routine laboratory tests (complete blood count, blood group, blood gas analysis, liver and kidney function tests, C-reactive protein, routine biochemical parameters such as electrolytes, CK, Myoglobin and troponin) and chest X-ray investigations. If necessarily applied, Abdominal ultrasound and Computed tomography (CT) of affected children were also documented. In addition, demographics like the patients' age, gender, ethnic origin, province of admission, how many days after they were admitted after the earthquake, whether they had a known chronic disease, and regular drugs used by children were recorded. In addition, positive physical examination findings such as; the signs of dehydration, hypothermia, hypotension/shock, the nature and the area of ​​injury, the time children were saved, duration of hospitalization, whether there is a need for surgical intervention, concomitant complications and presence of life-threatening condition (fracture, amputation, crush, soft tissue injury) were investigated. Treatment modalities and medications such as antibiotics and drugs that were initiated during hospitalization such as; oxygen, therapy for hydration, oral-enteral products, and nutritional requirements were recorded. Additional treatments like hemodialysis, hyperbaric oxygen, etc., and the prognosis of the patient, sequelae, and death were retrospectively scanned from the database. Also, the length of stay and the requirement for a referral to the pediatric intensive care unit (PICU) were documented for statistical evaluation. For our study, no additional tests were performed other than the materials obtained during routine treatment procedures stated by the government of Turkey. Neonates, patients with acute exacerbation of chronic diseases, recurrent admissions, patients who are hospitalized with a complaint/diagnosis other than related to the earthquake, adults (> 18 years), and incomplete medical records were excluded from the study. StatIstIcal AnalysIs The data were analyzed using the software, SPSS for Windows 25 (Statistical Package For Social Sciences Inc, Chicago, IL). Categorical variables were expressed as numbers and percentages. The distribution of continuous variables was investigated by Shapiro-Wilk and Kolmogorov-Smirnov normality tests. The mean and standard deviation values ​​were given for the data with normal distribution. In data that does not comply with normal distribution, the results are median (minimum and maximum) and given as a percentage. The collected data were analyzed using the Pearson Chi-Square test. The odds ratio (OR) was calculated for significant results. Multivariate analysis of independent variables was performed using Logistic Regression analysis and P values ​​<0.05 were considered statistically significant. Results A total of 356 children admitted to inpatient wards were included in the study. Of the patients 56.5% (n:201) were male and 43.5% (n:155) were female. Median age was 132 (min = 6, max = 216) months. There was no statistical significance (P > 0.05) regarding the effect of age and gender on parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and need for PICU. However, the type of injury was different between boys and girls. Injuries such as falling objects or slipping were more common in boys (P < 0.05). Considering the origins of the patients, 71.6% (n:255) were Turkish, while 28.4% (n:101) were Syrian nationals. When the provinces of the patients were examined, it was seen that most of them came from Hatay, with 91.9% (n: 327), Kahramanmaras followed this with 7.9% (n:28). Of the children, 11.2% (n:40) were admitted in the first 24 hours after the earthquake, 38.5% (n:137) were on the second day, and 44.7% (n:159) were on the third day. It was observed that 5.6% (n:20) were admitted to the hospital after the fourth day. When the chronic diseases of the patients were questioned, it was seen that only 0.9% (n:3) had a chronic disease (Diabetes mellitus etc.), and using medications due to their chronic disease. On physical examination, 11.8% (n:42) had signs of dehydration, 15.2% (n:54) had hypothermia or peripheral circulation disorder, and 7% (n:25) had hypotension/shock. Crush was noted in 41 dehydrated patients, 53 patients had hypothermia, and 24 patients had hypotension or shock. It was observed that the average length of stay of the patients was 6.7 ± 12.3 (median: 4, min = 1, max = 120) days. The most common injury was being trapped under rubble with 80.3% (n:286). This was followed by slipping with 9.3% (n:33), staying under falling objects with 6.7% (n:24), and falling from a height % of 3 (n:11). Soft tissue injury was present in almost all patients except for one patient. It was observed that the most common injury site was the lower extremities 60.4% (n:215), followed by the upper extremities 33.4% (n:119), head and neck injury in 27.8% (n:99) of children, spine injury in 13.2% (n:47), abdominal injury in 8.4% (n:30), 5.9% (n:21) had thorax injuries, and 4.8% (n:17) had pelvic injuries. Compartment syndrome developed in 31.7% (n:113) of the patients. It was observed that 98.3% (n:350) required a wound care practice and 84.6% (n:301) of the patients required a surgical intervention. Because some patients needed a multidisciplinary approach, they were evaluated by more than one department such as ophthalmology, otolaryngologist, etc. and when the departments of surgery requirement were evaluated, 56.7% (n:202) needed intervention in orthopedics, 42.1% (n:150) plastic surgery, 14.3% (n:51) neurosurgery, 10.4% (n:37) pediatric surgeon. The demographic characteristics of the patients and their clinical outcomes are summarized in Table 1 . The type of injury of the patients, the site of injury, and the departments involved in the surgical intervention are demonstrated in Table 2 . Table 1 Demographics of the patients and their and their clinical outcomes Variables n (%) P Value Crush S. P Value Fasciotomy P Value Amputation n = 356 Age, Mean ± SD (Median) 6 ± 216 (132) p > 0.05 p > 0.05 p > 0.05 Gender , n (%), Male 201 (56.5) p > 0.05 p > 0.05 p > 0.05 Female 155 (43.5) p > 0.05 p > 0.05 p > 0.05 Site, n (%) , Hatay 327 (91.9) p > 0.05 p > 0.05 p > 0.05 Kahramanmaraş 28(7,9) p > 0.05 p > 0.05 p > 0.05 Sanliurfa 1 (0.3) p > 0.05 p > 0.05 p > 0.05 Ethnicity, n (%) Turkish 255 (71.6) p > 0.05 p > 0.05 p > 0.05 Syrian 101 (28.4) p > 0.05 p > 0.05 p > 0.05 Admission day after the earthquake, n (%) First 24 hours 40 (11.2) P < 0.05 P 0.05 2 days 137 (38.5) p > 0.05 p > 0.05 p > 0.05 3 days 159 (44.7) p > 0.05 p > 0.05 p > 0.05 After day 4 20 (5.6) p > 0.05 p > 0.05 p > 0.05 Dehydration, n(%) 42 (11.8) p < 0.001 p 0.05 Hypothermia/Shock, n(%) 54 (15.2) p < 0.001 p 0.05 Hypotension/Shock, n(%) 25 (7) P < 0.05 p 0.05 Compartment syndrome, n(%) 113 (31.7) p > 0.05 p > 0.05 p > 0.05 Table 2 Injury type, injury site, departments involved in a surgical intervention n (%) n = 356 Injury type, n(%) Falling from height 11 (3) Object falling on 24 (6.7) Under the rubble 286 (80.3) Slip/Fall 33 (9.3) Others 2 (0.6) Injury site, n(%) Head neck 99 (27.8) Upper limb 119 (33.4) Spine 47 (13.2) Thorax 21 (5.9) Abdomen 30 (8.4) Lower limb 215 (60.4) Pelvis 17 (4.8) Departments involved, n(%) Orthopedics 202 (56.7) Neurosurgery 51 (14.3) Plastic surgery 150 (42.1) Wound care unit 350 (98.3) Others 37 (10.4) Various bone fractures were detected in 34.3% (n:122) of the patients. 16.6% (n:59) of the fractures were long bone fractures, 7% (n:25) had pelvis fractures, 6.5% (n:23) had vertebral fractures, and 6.2% (n:22) had skull and facial bone fractures. It was observed that 2.8% (n:10) of the patients were amputated. When the children were examined, crush syndrome was detected in 75.3% (n:268) of the patients with a high percentage due to the devastating effect of the earthquake. No statistically significant relationship was found between gender, nationality, presence of chronic disease, and crush syndrome (P > 0.05). Only one patient followed was dead. We observed that there was a significant difference between admission days and crush injuries (P = 0.001). Crush injury incidence was higher in patients admitted on the second day or later. In addition, when the relationship between the time the patient was admitted to the hospital and the requirement of fasciotomy was evaluated, a statistically significant difference was present (P 0.05). Creatine phosphokinase (CPK), myoglobin, kidney function tests (BUN, creatin), and liver function tests (AST, ALT) values were significantly higher in patients with crush injury and fasciotomy (P < 0.001). In those with elevated creatine phosphokinase (CPK), the likelihood of crush injury was found to increase 61 times (OR: 61.66, 95% CI). Moreover, it was determined that elevated CPK increased the risk of fasciotomy by 16.8 times (OR: 16.86, 95% CI). Additionally, there was a significant relationship between elevation of Myoglobin levels and crush injury/fasciotomy (P 0.05). Uric acid values were significantly higher in patients with crush injury (P = 0.005). Similarly, the rates of treatment regarding hyperbaric oxygen (HBO), hemodialysis or plasmapheresis, and development of sequelae were significantly higher in patients with crush injury (P < 0.05). Correspondingly, the rates of fasciotomy in patients receiving HBO were found to be highly significant (P < 0.001) as expected and the need for HBO treatment was high in amputated patients (P < 0.001). It was observed that 28.9% (n:103) of patients with crush syndrome required/underwent fasciotomy due to compartment syndrome and a significant relationship was found between crush injury and the need for a fasciotomy (P < 0.001). The likelihood of undergoing a fasciotomy was 26 times higher in patients with crush injury than in those without (OR: 26.00, 95% CI). Sixteen patients with crush syndrome were found to require hemodialysis/plasmapheresis (P < 0.05) and patients who underwent these interventions were also associated with fasciotomy (p = 0.002). It was determined that there was a strong relationship between dehydration and the development of crush injury and the need for fasciotomy (P < 0.001). We found that dehydration increased the risk of fasciotomy by 7.2 times (OR: 7.23, 95% CI) and the risk of amputation by 5.4 times (OR: 5.4, %95 CI). Furthermore, hypotension was associated with crush syndrome (P < 0.05) and fasciotomy (P < 0.001). Crush syndrome and the necessity of fasciotomy in children with hypothermia were also statistically significant (P < 0.001). It was determined that the average length of stay of the patients was 6.7 ± 12.3 (median:4, min = 1, max = 120) days. Of the patients, 41.6% (n: 148) required pediatric intensive care and 112 of the patients with crush were referred to another hospital (P < 0.001) after first aid was given and vital condition stabilized. After the earthquake, the blood gas tests of 91% of the victims (n: 324) were mostly found normal. It was observed that 5.3% (n:19) had metabolic acidosis, 2% (n:7) had metabolic alkalosis, and 1.7% (n:6) had respiratory acidosis. The laboratory test results of earthquake victims according to current reference values performed in the PED of our hospital and their relationship between crush syndrome, fasciotomy, and amputation are summarized in Table 3 . Table 3 a - The laboratory test results of earthquake victims and their relationship between crush syndrome, fasciotomy and amputation Low n(%) Normal n(%) High n(%) P Value P Value P Value Crush Syndrome Fasciotomy Amputation WBC 11 (3.1) 203 (57) 142 (39.9) p > 0.05 p > 0.05 p > 0.05 PLT 17 (4.8) 318 (89.3) 21 (5.9) p > 0.05 p > 0.05 p > 0.05 Hemoglobin 136 (38.2) 191 (53.7) 29(8,1) P < 0.05 P 0.05 HTC 136 (38.2) 192 (53.9) 28 (7.9) P < 0.05 P 0.05 MCV 34 (9.6) 319 (89.6) 3 (0.8) p > 0.05 p > 0.05 p > 0.05 Sodium 36 (10.1) 318 (89.3) 2 (0.6) p > 0.05 p > 0.05 p > 0.05 Potassium 4 (1,1) 308 (86.5) 44 (12.4) p > 0.05 p > 0.05 p > 0.05 Glucose 8 (2,2) 178 (50) 170 (47.8) p > 0.05 p > 0.05 p > 0.05 Calcium 116 (32.6) 236 (67.1) 1 (0.3) p > 0.05 p > 0.05 p > 0.05 Phosphorus 4 (1,1) 312 (87.6) 40 (11.2) p > 0.05 p > 0.05 p > 0.05 Magnesium 3 (0.8) 352 (98.9) 1 (0.3) p > 0.05 p > 0.05 p > 0.05 Albumin 38 (10.7) 317 (89) 1 (0.3) p > 0.05 p > 0.05 p > 0.05 Uric acid 11 (3.1) 286 (80.3) 59 (16.6) P = 0.005 P < 0.001 P 0.05 p > 0.05 p > 0.05 Lipase 2 (0.6) 336 (94.4) 18 (5.1) p > 0.05 p > 0.05 p > 0.05 Myoglobin 2 (0.6) 91 (25.6) 263 (73.9) P < 0.001 P 0.05 Table 3 b- The laboratory test results of earthquake victims and their relationship between crush syndrome, fasciotomy and amputation Normal n(%) High n(%) P Value P Value P Value Crush S. Fasciotomy Amputation CRP 90(25.3) 266(74.7) p > 0.05 p > 0.05 p > 0.05 ALT, AST 133(37.4) 223(62.6) P < 0.001 P < 0.001 P < 0.05 BUN,Kr 275(77.2) 81(22.8) P < 0.001 P < 0.001 P < 0.05 CPK 88(24.7) 268(75.3) P < 0.001 P 0.05 PT, PTT 239(67.1) 117(32.9) p > 0.05 p > 0.05 p > 0.05 There was a significant relationship between low Hemoglobin/Hct values (Anemia) and crush syndrome and fasciotomy (P < 0.05). Elevated uric acid levels were detected in 59 of the patients and it was significantly higher in patients with crush injury (P = 0.005). Fasciotomy was required in 31 of the patients with high uric acid, and it was observed that fasciotomy was highly required when the uric acid level was high (P < 0.001) and there was a significant relationship between high uric acid and amputation (P < 0.05) as well. Elevation of BUN and Creatin was detected in 81 of the patients and elevation of AST/ALT was detected in 223 patients. The development of crush syndrome and the need for fasciotomy were also higher in these patients (P < 0.001). Urine analysis was found to be normal in 31.5% (n:112) of the children who could undergo urinanalysis. It was observed that 14.6% (n:52) had hematuria, 1.4% (n:5) had anuria, and 0.3% (n:1) had pyuria. Chest radiography was not performed in 61.8% of the patients (n:220). While the chest radiography of 31.2% (n:111) of the patients was unremarkable, an important finding such as pneumothorax or pleural effusion was detected in 7% (n:25) of the victims. Abdominal ultrasound (USG) was performed in 8.7% (n:31) of the patients and 4.8% (n:17) of the victims had normal findings. On the other hand, the victims appeared to have an injury of their belly and underwent abdominal USG; intra-abdominal fluid or bleeding was detected in 2.6% (n:9), liver/spleen contusion in 1.1% (n:4) patients, and renal/urinary system contusion in 0.3% (n:1) patients. Computed tomography (CT) was not routinely performed in 18.3% (n:65) of the patients and 47.8% of the CT scans were reported as normal. According to CT scan reports, 10.4% (n:37) of the patients had various bone fractures, 5.9% (n:21) had soft tissue injuries, 5.3% (n:19) had intracranial hemorrhage, 2 patients (0.6%) had diffuse axonal damage, 3.7% (n:13) had serious thorax injuries such as lung contusion, pneumothorax, mediastinum, emphysema and pleural effusion. Of the victims, 1.7% (n:6) had injury/bleeding/hematoma in the internal organs of the abdomen and it was observed that 6.2% (n:22) of the patients had injuries in more than one region of their body. The treatments initiated for the patients, nutritional status, interventional procedures, and clinical outcomes of victims are shown in Table 4 . Table 4 Treatments initiated, nutritional status, interventional procedures and clinical outcomes of victims n (%) Oxygen 23 (6.5) Parenteral hydration 356 (100) 1/2 isomix solution 293 (82.3) 5% Dextrose 55 (15.4) 1/3 isomix solution 8 (2,2) Oral nutrition (Age specific) 289 (81.2) Enteral products 12 (3.4) Antibiotics 319 (89.6) Hyperbaric oxygen treatment 28 (7.9) Tetanus prophylaxis 356 (100) Hemodialysis/Plasmapheresis 16 (4.5) Pediatric intensive care admission 148 (41.6) Referred to another hospital 112 (31.5) Sequelae status 28 (7.9) Death 1 (0.3) DISCUSSION In this study, we aimed to analyze the experiences and clinical outcomes of children victims admitted to a tertiary research hospital after a sudden earthquake, to improve future preparedness associated with access to essential health services, to strengthen the emergency response system, and to reduce losses in case of a future disaster. This study demonstrated that the gender of the patients were evenly distributed and this was consistent with the literature ( 6 ). Of the victims, the mean age was ≈ 127 months. A total of 119 patients, < 16 years of age (mean 9.4 ± 4.8 years), were assessed and hospitalized in one of Tehran's hospitals within one week of the Bam earthquake ( 7 ). Age and gender characteristics vary depending on the nature and inclusion criteria of the studies, and there is no other study showing the age range in children. The number of studies in this field is few, considering the adult age group with limited resources. Therefore, this study conducted comprehensively in the pediatric age group will be the first in the literature. It was observed that age and gender did not affect parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and the need for PICU. As authors we have to state that; even though the region of our hospital is comparatively (273 km) away from the origin of the earthquake, our experiences showed that it was felt with a Richter scale magnitude of more than 6, we have caught it while sleeping and experienced relatively mild but a seriously frightening earthquake with the same scenario. Injuries such as falling objects or slipping were more common in boys than in girls. This might be because boys are more active and energetic than girls and they tended to run to other rooms near family members ( 8 ). While the majority of the patients were Turkish, approximately one-third were Syrian nationals probably because the patients commonly came from the Hatay district which is nearby Syria and approximately 50% of the total number of Syrians in Turkey live in 11 provinces affected by the earthquake ( 4 ). In a study conducted after an earthquake, it was reported that 754 of 1582 patients were admitted within the first 24 hours ( 9 ). Similarly, in the Taiwan earthquake, it was reported as 66.2% ( 10 ), and 42% of the patients applied on the first day of an earthquake in our country ( 1 ). In our study, unlike the literature, we found that most of the patients (44.7%) applied on the 3rd day. This situation can be explained by the difficulty in responding to the debris due to its destructive nature and the difficulty in transportation. Almost all (95%) children were admitted to the hospital during the initial three days. This showed us that government’s health response must be urgent and powerful at first 3 days. The victims may lose fluid to the third cavities, primarily through the skin, and since fluid intake is not possible, dehydration occurs. Hence, in the early period, almost all patients with rhabdomyolysis are hypovolemic. Since earthquakes happen in winter, severe and prolonged hypothermia may also cause rhabdomyolysis, and bleeding from any cause also contributes to hypovolemia. Outcomes of patients with crush syndrome vary greatly depending on the organ and system it affects. The most common findings are acute renal failure (ARF), hypotension, shock, cardiac and respiratory failure ( 11 ). Similar to the literature, in our study, it was observed that there was a significance in terms of crush syndrome and the need for fasciotomy in dehydrated patients, who had hypotension/shock and hypothermia. In our study, the average length of stay of the patients was found to be 6.7 days. The mean length of hospital stay of earthquake victims in Tuth, was equal to 14.7 with a median of ten days, respectively, which was higher than ours. A study in a rural hospital in Nepal showed that earthquake victims had a median length of stay of 8 days. In another study involving admitted victims of the Wenchuan earthquake, their mean length of hospital stay was 7 days, ranging from one to 120 days similar to our study ( 12 , 13 ). In another study, the mean duration of hospitalization was 1.4 days. Twenty-two children (8.2%) were hospitalized for 4 days and the median length of stay was 13 days (range: 1 to 87 days) ( 14 ). The majority of earthquake-related injured patients achieved care during the first 4 weeks of the response. We believe that the difference in days in the studies might be because the severity of the earthquake and the number of patients affected vary according to the different landscapes of various countries. The majority of deaths and injuries during earthquakes occur as a result of being buried under collapsed rubble. Although early fatal injuries generally occur due to the collapse of building stuff, such as columns, beams, walls, etc., a significant portion of those who survived the disaster were injured by household items ( 11 , 15 ). For this reason, to prevent injuries fixing household items to the wall is recommended as a simple but very effective method ( 15 ). Some earthquake victims jump out of windows of their own free will and are injured due to the impact of the event. It has been reported that the risks of death and injury of earthquake victims are closely related to the floor they live on. Accordingly, those living on the upper floors are exposed to a more serious risk of injury ( 16 ). It is stated that superficial erosions, penetrating traumas, and/or fractures can be seen in those who fall from lower floors to the ground, whereas fatal blunt or penetrating traumas are more common in those who fall from upper floors ( 11 , 16 ). In our study, consistent with the literature, it was observed that the most common type of injury was being trapped under rubble, followed by slipping, falling on an object, and falling from a height. In our study, soft tissue injury was present in almost all patients. When all hospital admissions during the Armenia earthquake were reviewed, soft tissue injuries such as laceration and contusion were the most common (24.9%), followed by head traumas (22%), lower extremity traumas (19%), crush syndrome (11%) and upper extremity traumas (10%) ( 17 ). In Southern Italy, approximately half of the disaster victims were injured in more than one part of the body, and the most frequently reported type of injury was laceration ( 18 ). Reports on the type of injury vary significantly between disasters. The best example of this is the two earthquakes in the USA. Although no head trauma was reported in the Loma Prieta Earthquake, head trauma was reported at a rate of 11.9% in the Northridge earthquake ( 15 ). In our study, it was observed that many procedures such as soft tissue debridement, repair of skin lacerations, and suturing of wounds were performed bedside under sedation/analgesia in pediatric wards. Similar rates and interventions are available in the literature ( 19 – 21 ). In our study, the frequency of crush injury and fasciotomy was high in patients who were trapped under collapsed rubble. As expected, the earthquake victims required consultation with the Department of Orthopedics mostly. This was similar to the pattern of earthquake injuries reported in the literature ( 22 , 23 ). In another earthquake in our country, 66% of patients admitted to the hospital had extremity injuries ( 1 ). Xiang et al. reported that orthopedic injuries accounted for 81% of all pediatric injuries after the China earthquake ( 24 ). In our study, two-thirds of the patients were treated by the Department of Orthopedics. One-third had various bone fractures. Long bone fractures accounted for more than half of the cases, with the lower extremities being the most common body location. This is in agreement with other studies that reported extremity injuries as the most common types of injuries ( 1 , 6 , 7 , 12 , 25 – 27 ). In our findings, unlike the literature, it was observed that extremity injuries were followed by head/neck, vertebra, abdomen, thorax, and pelvic injuries respectively. Tanaka et al. reported that less than 7.5% of earthquake victims had head, chest, and abdominal injuries during the Hanshin-Awaji earthquake ( 28 ). Non -orthopedic injuries such as head, chest, and abdomen are generally more severe and fatal. It is assumed that children with injuries in the form of severe head trauma do not survive the initial trauma. In our study, head traumas were very high percentage 27.8%, unlike the literature. Bulut et al. reported a 7% prevalence of head injuries during post-disaster response in our country ( 1 ). In studies conducted on earthquake-related head trauma in pediatric patients, Farfel et al. reported 3.2% of head trauma, while Zhao et al. reported 12% of head injuries ( 19 , 29 ). In a recent study conducted in the general population regarding this earthquake, the most common type of injury was head trauma, which was consistent with our study ( 30 ). The field of pediatrics is still untouched regarding earthquake preparedness and more studies are needed because the distribution of the injuries and care strategies of children differ extremely from adults. Crush syndrome is one of the most common and fatal clinical manifestations of earthquakes, if not treated quickly. After the Marmara earthquake, the authors stated that crushing injury to a large skeletal muscle mass, sensory and motor disorders in the extremities, myoglobinuria and/or hematuria, and serum CPK levels > 1000 U/L were the diagnostic criteria for crush syndrome in the children they followed ( 31 ). Causes of death included hypovolemic shock, hyperkalemia, hypocalcemia, metabolic acidosis, myoglobinuria, compartment syndrome, and ARF ( 32 ). After the Armenian earthquake, 600 crush syndrome cases were reported ( 33 )and 372 cases were reported after the Hanshin-Awaji earthquake which they used serum CPK concentration as an indicator of muscle damage ( 34 ). The number of studies in this field is few, considering the adult age group with limited resources. In our study, 268 children had crush syndrome (75.3%), which was a very high rate among the entire hospitalized patient population. During the Kobe earthquake; they found a close relationship between crush syndrome and serum myoglobin or serum CPK concentrations ( 35 ). Similarly, CPK, myoglobin, BUN, Cr and ALT, AST values were quite high in patients with crush injury ( 36 ). In our study, for those with elevated CPK, we have found the likelihood of crush injury to increase 61 times. Elevated CPK and myoglobin were also associated with crush injury and fasciotomy, and elevated CK increased the risk of fasciotomy by 16 times. Our clinical experience; showed that the increase in serum myoglobin and CPK levels can be used as an indicator of the severity of muscle damage of children victims to predict crush injury and to apply early fasciotomy to prevent amputations. It was observed that compartment syndrome developed in 31.7% (n = 113) of cases with crush injury and fasciotomy was performed in 28.9% (103 cases). This figure was found to be similar to some publications in the literature ( 37 ). The need for hyperbaric oxygen, hemodialysis, or plasmapheresis treatment was significantly higher in patients with crush injuries. Another study showed that fasciotomy was required in only 13.1% of patients with crush syndrome ( 34 ). The fact that there is a significant relationship between crush injury and the need for fasciotomy (crush injury increased fasciotomy incidence by 26 times) and the high rate of fasciotomy may be due to the high number of crush cases we had. When the relationship between the time elapsed after the earthquake until the patient was admitted to the hospital and the development of crush syndrome/fasciotomy was evaluated, it was determined that the later the arrival, the more crush developed and fasciotomy was performed. On the contrary, there was no relationship between admission time and amputation. We interpret this as meaning that amputation of the extremity was probably prevented by rapid fasciotomy and effective treatments. The need for HBO was significant in patients who developed crush injuries and underwent fasciotomy. Dehydration was also associated with fasciotomy rates, and it increased the risk of fasciotomy by 7.2 times. The development of crush syndrome and fasciotomy requirement increased in children experiencing hypotension and hypothermia. There are large differences in amputation rates in patients with crush syndrome in the literature. Guidelines recommend amputation to be performed if saving a limb is not possible or if injuries to the limb would cause sepsis or uncontrollable bleeding ( 38 ). In an earthquake in our country, ≈ 15% of the victims underwent amputation ( 37 ). Although amputation was performed in 6 out of 202 cases (2.9%) in Kobe ( 34 ), above-knee amputations were performed in 4 out of 15 patients (26.6%) in Armenia ( 39 ). After the Hanshin-Awaji earthquake, it was reported that 6 of 317 patients underwent primary amputation and 70 underwent fasciotomy ( 28 ). In a short study of earthquake victims of all age groups, amputation was reported in 7 cases. In our study, only 2.8% (10 cases) of the patients were amputated, which was lower than the literature ( 5 ). It was observed that none of them underwent primary amputation, and 10 of the patients with crush syndrome underwent secondary amputation. We think that the reason for our low amputation rate is that; since an extraordinary circumstance developed, our tertiary PICU intervened by increasing its capacity by 4 times and as a result, successful case management was achieved and timely effective interventions prevented amputation of the extremity of vulnerable children. Crush injury and fasciotomy were more common and the risk of amputation increased 5.4 times in dehydrated patients. Therefore, it is very important to hydrate the child early and it is also recommended in the literature to start intravenous fluid therapy before admission to the hospital and even during extraction from the rubble ( 38 ). In a study examining patients with crush injury, the need for surgical intervention was less and complications that may occur during the treatment of crush syndrome were low in the group receiving HBO treatment ( 40 ). After two earthquakes in our country, HBO treatment was applied to 28 patients ( 11 ) and 24 of the patients ( 5 ). In our study, it was applied to 28 patients, and the rate of HBO treatment was high in amputated patients. The reason for this might be that severe patients in poor general condition went to HBO treatment and therefore their need for amputation was significant. In a study, 477 (9.0%) of 5302 patients hospitalized needed dialysis support ( 37 ). In another study 33 patients were admitted during the earthquake, they detected crush injuries in 15 cases and ARF developed in 10 of them. They reported that two patients required hemodialysis despite aggressive fluid treatments. They stated that since ARF is only seen in children with crush syndrome, it was the main cause of ARF in pediatric patients trapped under rubble ( 41 ). In another study conducted, 14 (67%) of the patients who underwent fasciotomy had ARF, and 11 of these were treated by hemodialysis ( 42 ). Again, in the Wenchuan Earthquake, ARF occurred in 62 (41.6%) of a total of 149 patients with crush syndrome, and 33 of them received hemodialysis ( 43 ). In a preliminary study about the 2023 Maraş earthquake, 4 of the surviving children were treated with hemodialysis ( 5 ). In our study, patients who underwent hemodialysis/plasmapheresis were associated with fasciotomy, and 16 of the patients with crushes needed these interventions. There was no amputation in any of the patients. We think these results show that our treatments were effective. In a recent study of the 2023 earthquake, it was observed that 57.3% (35 cases) of 61 surviving children required PICU ( 5 ). Similarly in our study, 41.6% of the patients were found to require PICU care. In another local study of the 2023 Maraş earthquake, the rate of admission to pediatric intensive care was 0.3% ( 44 ). Once more, in a study investigating the frequency and mortality rate of post-traumatic ARF in children, it was observed that one-quarter of the victims developed ARF, and more care should be taken in the management of traumatized children, especially those who were taken to PICU. When the blood gas results of the cases after the earthquake were examined, it was seen that 5.3% had metabolic acidosis, 2% had metabolic alkalosis, and 1.7% had respiratory acidosis. Our study is very comprehensive in this regard and no publication has been found in the literature about this context to make a comparison. Anemia is a common finding in earthquakes due to many reasons such as bleeding due to trauma or surgical interventions ( 11 ). It has been reported that anemia was the most common laboratory finding in patients monitored after the Mexico earthquake ( 45 ). It is vital to keep the blood Hemoglobin/Hct level within certain limits to ensure tissue oxygenation and perfusion in earthquake victims. Therefore, it is recommended to measure Complete blood count (CBC) as a screening test in critically ill patients to determine the prognosis ( 46 ). In our study, similar to the literature, low hemoglobin, and Hct values were observed in 38% of the patients. This can be explained by blood loss due to trauma when we consider the serious impact of the earthquake. In contrast, 8% of patients had high Hct values at the time of admission. It has already been known that high hematocrit levels can be observed in patients during an earthquake because of hemoconcentration due to dehydration ( 47 ). The frequency of anemia was also noted in the blood counts of victims with Crush syndrome during the Marmara earthquake ( 11 ). In our study, we found that children with low Hb/Hct were prone to crush syndrome and the need for fasciotomy was greater. Rhabdomyolysis is a common complication in patients with crush injuries, and a CPK level elevating more than five times above normal or a value of > 1,000 U/L is used to diagnose this condition ( 48 ). In a study serum CPK levels were found to be high in all patients ( 31 ). We found that the CPK value was high in 75.3% of the patients, similar to the literature. Serum myoglobin level has not been determined in patients after the earthquake in our country and has not been used for diagnostic purposes due to its short half-life and the need for special techniques for measurement. In our study, elevated Myoglobin levels were detected in 263 (73.9%) patients. As authors, we were not sure whether this data was meaningful, but still, the studies on these subjects are very valuable, so we wanted to share our data with you. Additionally, liver enzymes such as ALT and AST increase after rhabdomyolysis ( 31 , 49 , 50 ). In our study, this elevation was detected in 205 patients, and in line with the literature, the development of crush syndrome and the need for fasciotomy were found to be significantly higher in these patients. In a study investigating the prevalence of post-traumatic acute kidney injury (AKI) in children victims, the prevalence was found to be 24.6% ( 51 ). In our study, the elevation of BUN and Creatin was detected in 81 of the patients, and crush syndrome and the need for fasciotomy were significant in these patients. Hyperuricemia is very common in ARF due to rhabdomyolysis ( 50 , 52 , 53 ). The serum uric acid level of these patients increases disproportionately with their renal functions ( 54 ). Similar to the literature, high Uric acid levels were detected in 59 of the patients and it was found to be higher in patients with crush injury. Fasciotomy was required in 31 of the patients with high uric acid levels, and it was observed that this increase was associated with amputation. As the authors, we recommend being careful with high BUN, Cr, ALT, AST, and uric acid levels and following up with the victim more closely. Half of the patients underwent urinalysis, and results were unremarkable in 32% of them. Hematuria was observed in 15% (52 cases), anuria was observed in 1.4% (5 cases), and pyuria was observed in one case. In pediatric trauma cases, X-rays, USG, and CT scans are used to detect damage quickly ( 55 ). The most common lung injuries in children during earthquakes are; lung contusion, pneumothorax, and hemothorax. Sometimes, although plain radiographs seem to be normal, parenchymal injury and contusion areas can be detected in thorax CT images ( 56 ). In our study, 31% of those who had chest X-ray was normal, but an important finding such as; pneumothorax or pleural effusion was detected in 7% (25 cases). In a study conducted to evaluate the role of USG in diagnosis among earthquake victims, Fayyaz et al. found that it has an important diagnostic value in natural disasters. In addition, Thorax USG was useful in detecting intraperitoneal fluid and free air, suggesting the level of organ injury, and retroperitoneal injuries and deciding on conventional treatment ( 57 ). In a study conducted after the earthquake in Lu-Shan city, massive fluid in the abdomen resulting from liver and spleen injury was detected in 8 of 38 patients who underwent abdominal USG. Pericardial effusion was detected in 1 patient, pneumothorax in 2 patients, massive pleural effusion in 1 patient, and collapse of the inferior vena cava was detected in 9 patients ( 58 ). In our study, 5% of the patients (17 cases) had normal abdominal USG findings. On the other hand, free intra-abdominal fluid or intra-abdominal bleeding was detected in 2.6% of the patients (9 cases), while 4 patients had liver/spleen contusion and one patient had renal/urinary system injury. Since the type of injury in pediatric earthquake victims is different from that in adults, CT imaging provides rapid diagnosis shortening the time to start life-saving treatments ( 59 ). CT is a valuable diagnostic tool for detecting head, chest, spine, abdominal and pelvic injuries ( 60 ). At the 2023 Maraş earthquake, the most common injuries were head trauma (18.7%), followed by thoracic injury (15.6%), spinal injury (8.5%), pelvic fracture (7.4%), abdominal injury (3.9%), and maxillofacial fracture (2.3%). Moreover, pulmonary contusion was the most common CT finding among earthquake-related thoracic injuries ( 30 ). While half of the CT scans taken were interpreted as normal, 10.4% (37 cases) showed various bone fractures, 6% (21 cases) showed soft tissue injury, 5.3% (19 cases) showed intracranial hemorrhage, 4 (13 cases) had serious thorax injuries such as lung contusion, pneumothorax, emphysema, pleural effusion, and 2% (6 cases) had injury/bleeding/hematoma in the internal organs in the abdomen. Our patients rescued from the rubble were first rehydrated and hemodynamically stabilized with intravenous fluid therapy. Early fluid therapy is vital to minimize the risk of AKI due to crush syndrome. We found that 82.3% of the children was hydrated with ½ isomix solution which was most similar solution in terms of content to isotonic solutions with appropriate potassium chloride and dextrose recommended by The American Academy of Pediatrics to decrease the risk of developing hyponatremia. However, 15.4% was hydrated with %5 Dextrose solution and 2.2% was with 1/3 isomix solution. The reason for this mistake might be because first rescue responders were not specialist of pediatrics. It is necessary to provide training and support to rescue teams regarding hydration solutions with appropriate content. Data obtained from children after an earthquake showed that AKI did not occur in patients who started early fluid therapy ( 31 ). Similarly, studies conducted during the BAM earthquake in Iran have shown that early intravenous volume replacement prevents both ARF and the need for dialysis in children ( 61 ). Infections are also one of the most common factors contributing to mortality in trauma patients which wound infections are mostly encountered. It may occur in the early period with the deterioration of skin integrity due to trauma, the presence of necrotic tissue, or in the late period with surgical or invasive interventions (amputation, debridement, fasciotomy, exploration) performed in intensive care units ( 62 , 63 ). In our study, almost all patients received intravenous systemic antibacterial drugs, especially Ampicillin-Sulbactam similar to the literature ( 19 ). In addition, all victims were vaccinated regardless of their vaccination status, considering the possibility of tetanus. It is known that prophylaxis measures must be taken by implementing similar approaches in previous disaster situations ( 1 , 19 , 64 ). As authors, we are aware of the limitations of the manuscript related to its single-centered and retrospective design. However, the strength of our article is that there is no such comprehensive study about children regarding emergency health services and clinical outcomes among disaster victims. Therefore, it was difficult to access some data in the discussion. Since our hospital was at a close location near the earthquake, it has quadrupled its capacity in this emergency condition, by the way we have accessed the data of a large number of pediatric patients. To accommodate rapid patient circulation, a central triage system was established in our hospital, taking into account the patients' ages, general conditions, and medical problems. Such organizations still have challenges as solutions need to be found urgently. This issue was touched upon in a study conducted in China and the difficulties of efficient triage after the earthquake were discussed ( 24 ). The initial approach should be to prevent damage and complications that may occur gradually with non-surgical treatments and be ready to proceed with a surgical procedure immediately if necessary. We, as a pediatrics team in a tertiary research hospital setting, had the privilege to assist injured and sick children affected by this sudden unexpected disaster. Therefore, we wish to share our experiences with our colleagues worldwide. Countries must be prepared in case of natural disasters and must have trained health professionals, auxiliary health personnel, and adequate equipment. We need to learn more about medical response and procedures for children and enhance the development of efficient algorithms and procedures for better preparedness for sudden disasters. Conclusions A major earthquake is a destructive event that creates a chaotic situation. Dehydration, hypotension and shock was related to crush injury and the need for fasciotomy. Compartment syndrome and bone fractures may develop in one third of the children. Anemia and biochemical parameters must be followed and elevated CPK, myoglobin and uric acid levels are highly associated with fasciotomy and amputation. Therefore, for the development of preparedness and recovery policies for future disasters the clinical outcomes of children is crucial and treatments like fasciotomy, hyperbaric oxygen, hemodialysis/plasmapheresis must be administered timely to prevent amputation and development of sequelae. Early intervention should be carried out by a good medical team supported by strong logistic aid systems. Declarations Funding Source: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Financial interest: The authors have no relevant financial or non-financial interests to disclose. Compliance with Ethical Statement Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose. Author Contributions: Şefika Aldaş; had primary responsibility for protocol development, patient screening, enrollment, outcome assessment, preliminary data analysis and writing the manuscript. Murat Ersoy, Ali Tunç, Esra Vatansever, Suna Ozdem had primary responsibility for protocol development, outcome assessment. Gamze Gökulu, Fatma Sercan Aynacı, Banu Katlan; had primary responsibility for protocol development, patient screening, enrollment. Mehtap Durukan Tosun, Berfin Ozgökçe Ozmen; participated in the development of the protocol and analytical framework for the study. Sanliay Sahin; supervised the design and execution of the study, reviewed and revised the manuscript. All authors contributed to the study conception and design and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Toros University with registration number DEISC-PR-26.04.2023/46. Consent to participate Informed consent was obtained from all individual participants included in the study. 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The spectrum of rhabdomyolysis. Medicine. 1982;61(3):141-52. Honda N. Acute renal failure and rhabdomyolysis. Kidney international. 1983;23(6):888-98. Aydın ZB. Evaluation of pediatric high-energy trauma patients with whole-body computed tomography. Nigerian journal of clinical practice. 2021;24(1):127-31. BALCI Ö. Depremde Yaralanan Çocukların Değerlendirilmesi; Çocuk Cerrahisi Yaklaşımı. Ahmad F, Mahmood T, Memon AS, Jamali A, Abbas K. Ultrasound imaging in settings of a natural disaster: experience from october 8th 2015 earthquake in Pakistan. Liaquat medical research journal. 2019;1(2):35-9. Zhang S, Zhu D, Wan Z, Cao Y. Utility of point-of-care ultrasound in acute management triage of earthquake injury. American Journal of Emergency Medicine. 2014;1(32):92-5. Shannon L, Peachey T, Skipper N, Adiotomre E, Chopra A, Marappan B, et al. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. Clinical radiology. 2015;70(11):1205-11. Didion P, Crombé A, Dabadie A, Hassid S, Seux M, Gorincour G, et al. Emergency whole-body CT scans in pediatric patients with trauma: patterns of injuries, yield of dual-phase scanning, and influence of second read on detection of injuries. European radiology. 2022;32(12):8473-84. Sanadgol H, Najafi I, Vahid MR, Hosseini M, Ghafari A. Fluid therapy in pediatric victims of the 2003 bam, Iran earthquake. Prehospital and Disaster Medicine. 2009;24(5):448-52. Demir BK, Başaran C. Deprem sonrası çocuk hasta, ezilme (crush) sendromu. TOTBİD Dergisi. 2022;21. Xiaolei C, Hui Z, Ping F, Zhangxue H, Wei Q, Ye T. Infections in crush syndrome: a retrospective observational study after the Wenchuan earthquake. Emergency Medicine Journal. 2011;28(1):14-7. Guha-Sapir D, van Panhuis WG. Health impact of the 2004 Andaman Nicobar earthquake and tsunami in Indonesia. Prehospital and disaster medicine. 2009;24(6):493-9. 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ALDAŞ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDCCA0BcYZDAwMDOYABkAXnMzA2EtZwBaWEGaTkD0sJIjBYGqBbGNpAQAS18t48/fHCgIE2ev5l548ef82qj+duBWn5UbMOpRfJcjrHBAYMcwxmH2Yqlebcdz51xmLGBsefMbZxaDM7wsEl/MKhgbDjMYyDNuO1YbgNQCzNjGz4t7M9/HDCosJ9/mMf45885x3LnE9bCYMYAdFjihsM8ZhK8DTW5GwhpkTzDYyxxwCAteeNhtjJrnmMHcjcCtRzE5xe+M+wPPxz4k2w773jz5ps/aupy550/fPDBjwrcWtDBYTB5gGj1QFBHiuJRMApGwSgYIQAAP4dhOXGRDbkAAAAASUVORK5CYII=","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Şefika","middleName":"","lastName":"ALDAŞ","suffix":""},{"id":265109505,"identity":"b7c0ec45-a9cb-4f47-afb8-51f26faf3000","order_by":1,"name":"Murat Ersoy","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Ersoy","suffix":""},{"id":265109506,"identity":"cbe624c0-8ea6-42e1-ae7a-1dc1056116da","order_by":2,"name":"Mehtap Durukan Tosun","email":"","orcid":"","institution":"University of Health Sciences, Mardin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mehtap","middleName":"Durukan","lastName":"Tosun","suffix":""},{"id":265109507,"identity":"47ec1f81-fa06-42cd-88fa-97466add101b","order_by":3,"name":"Ali Tunç","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Tunç","suffix":""},{"id":265109508,"identity":"c225d3a0-1b31-4161-8dac-93210e89856c","order_by":4,"name":"Gamze Gökulu","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gamze","middleName":"","lastName":"Gökulu","suffix":""},{"id":265109509,"identity":"b7766a88-1cc6-4284-8eff-a4fbc8273a03","order_by":5,"name":"Esra Vatansever","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"","lastName":"Vatansever","suffix":""},{"id":265109510,"identity":"a74dd810-0680-4094-9d69-7d3fea4c836a","order_by":6,"name":"Fatma Sercan Aynacı","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"Sercan","lastName":"Aynacı","suffix":""},{"id":265109511,"identity":"eb925b6e-3b38-49fd-8748-63e3d3fcee9f","order_by":7,"name":"Banu Katlan","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Banu","middleName":"","lastName":"Katlan","suffix":""},{"id":265109512,"identity":"f3e367b7-3a0a-4671-971c-7c799d6b066f","order_by":8,"name":"Suna Ozdem","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Suna","middleName":"","lastName":"Ozdem","suffix":""},{"id":265109513,"identity":"dbf8f7cd-151a-4dd2-9ec0-906e253cb5cc","order_by":9,"name":"Berfin Ozgokçe Ozmen","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Berfin","middleName":"Ozgokçe","lastName":"Ozmen","suffix":""},{"id":265109514,"identity":"d95c4951-19f7-4383-92fe-fa0fcebd1c30","order_by":10,"name":"Şanlıay Şahin","email":"","orcid":"","institution":"University of Health Sciences, Mersin City Education and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Şanlıay","middleName":"","lastName":"Şahin","suffix":""}],"badges":[],"createdAt":"2023-12-26 11:59:21","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3807964/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3807964/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49229322,"identity":"994c1433-9fe5-4efb-900e-fcc68a269bb7","added_by":"auto","created_at":"2024-01-05 15:37:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":504932,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3807964/v1/edebfb25-825a-4710-9a13-0d73218ee56c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDisaster of the Century, 2023 Earthquake of Turkey: How Can We Prevent Amputation of Children\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLarge scale, sudden-onset natural disasters occur unexpectedly which disturb the normal order of life beyond the adaptive capabilities causing widespread destruction and resulting in high numbers of injuries, disabilities, and death. In addition, it paralyzes the local health care system and social welfare institutions, resulting in morbidity and mortality and giving rise to critical requirements for external aid and urgent external assistance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Formerly earthquakes hit countries such as; Guatemala (23,000 deaths), Southern Italy (2,735 deaths), Armenia (24,944 deaths), the Philippines (1,600 deaths), Iran (32,500 deaths), India (9,475 deaths), Japan (6,308 deaths), Russia (1,989 deaths) and China (322 deaths), Taiwan (2,100 deaths), Iran (30,000 deaths) leading to large number of people being homeless (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). An earthquake with a Richter scale magnitude of 7.7 occurred on February 2023, at 04:17 am, first lasting for 80 seconds, with 3 consecutive catastrophic shocks. The epicenter was located on Kahramanmaras which is on the eastern Anatolia fault line surrounding a densely populated region of 11 provinces. Approximately 14\u0026nbsp;million people live in the provinces affected by the earthquake, and the number constitutes approximately 13.4% of Turkey's population. Of the child population in our country, 21.3% live in regions affected by the earthquake. The origin was approximately seven kilometers deep, the surface area of the earthquake zone was 13.9 thousand km\u0026sup2; and the area constituted approximately 17.8% of Turkey. The second earthquake with a magnitude of 7.6 occurred 9 hours later and caused much greater effect causing the debris fields to collapse further and resulting in the buildings to collapse which were not damaged in the first earthquake. Within hours, the government made an official request for international assistance and a Level 3 emergency was pronounced by the director of the World Health Organization (WHO) after the earthquakes. The Turkish Ministry of Interior Disaster and Emergency Management Presidency (AFAD) released an official announcement informing the public that 2,724 aftershocks occurred in the first week following the earthquake. As of May 2023, the earthquake had killed at least 50,783 people and injured an additional 158,165 people, and more than 202,000 buildings were announced to be demolished or heavily damaged (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). During the earthquake, people were asleep in homes, and they couldn\u0026rsquo;t get out, escape, or seek for care. Many children had lost their homes and loved ones and faced the predicament of the lack of schools and medical treatment. Accordingly, thousands of buildings collapsed and many people were trapped under the rubble. They could not be rescued within hours to days of the initial earthquake. Additionally, due to the hurry to provide emergency care, victims were separated from their families, some of whom were taken to the nearest health organization. Moreover, the earthquake also damaged hospitals in the region, forcing victims to go to other cities\u0026rsquo; hospitals far away (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It is extremely important to define the clinical profile of earthquake victims admitted in emergency situations and to determine the characteristics of children who are one of the most vulnerable and affected populations of the community. Providing emergency trauma treatment and critical medicines, emergency kits, and supplies to meet urgent requirements, especially among children is very important including post-traumatic rehabilitation for the injured ones. The literature lacks evidence about characteristics, and clinical outcomes among children victims regarding emergency health services. Therefore, we aimed to analyze the experiences and clinical outcomes of children admitted to a tertiary research hospital after the earthquake, to improve future preparedness associated with access to essential health services, and to strengthen the emergency response system and the strategy for diminishing amputation/sequelae in case of a future disaster setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e After approval from the Ethical Committee of Toros University with registration number DEISC-PR-26.04.2023/46, all admissions of earthquake victims from 6 February to 6 March 2023 were analyzed consecutively in concordance with the Helsinki Declaration. The pediatric inpatient clinic is a 90-bed, multidisciplinary, tertiary referral and trauma center for infants and children. A total of 356 children between the ages of 1 month and 18 years, who came from affected 11 provinces and were referred from the pediatric emergency department (PED) of the hospital were scanned from the hospital database system and included in the study. Earthquake victims were defined as children admitted with a clinical condition directly related to the earthquake. All patients were subjected to medical history, vital signs, state of hydration, behavioral state, pulse oximetry, physical examination, and routine laboratory tests (complete blood count, blood group, blood gas analysis, liver and kidney function tests, C-reactive protein, routine biochemical parameters such as electrolytes, CK, Myoglobin and troponin) and chest X-ray investigations. If necessarily applied, Abdominal ultrasound and Computed tomography (CT) of affected children were also documented. In addition, demographics like the patients' age, gender, ethnic origin, province of admission, how many days after they were admitted after the earthquake, whether they had a known chronic disease, and regular drugs used by children were recorded. In addition, positive physical examination findings such as; the signs of dehydration, hypothermia, hypotension/shock, the nature and the area of ​​injury, the time children were saved, duration of hospitalization, whether there is a need for surgical intervention, concomitant complications and presence of life-threatening condition (fracture, amputation, crush, soft tissue injury) were investigated. Treatment modalities and medications such as antibiotics and drugs that were initiated during hospitalization such as; oxygen, therapy for hydration, oral-enteral products, and nutritional requirements were recorded. Additional treatments like hemodialysis, hyperbaric oxygen, etc., and the prognosis of the patient, sequelae, and death were retrospectively scanned from the database. Also, the length of stay and the requirement for a referral to the pediatric intensive care unit (PICU) were documented for statistical evaluation. For our study, no additional tests were performed other than the materials obtained during routine treatment procedures stated by the government of Turkey. Neonates, patients with acute exacerbation of chronic diseases, recurrent admissions, patients who are hospitalized with a complaint/diagnosis other than related to the earthquake, adults (\u0026gt;\u0026thinsp;18 years), and incomplete medical records were excluded from the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatIstIcal AnalysIs\u003c/h2\u003e \u003cp\u003eThe data were analyzed using the software, SPSS for Windows 25 (Statistical Package For Social Sciences Inc, Chicago, IL). Categorical variables were expressed as numbers and percentages. The distribution of continuous variables was investigated by Shapiro-Wilk and Kolmogorov-Smirnov normality tests. The mean and standard deviation values ​​were given for the data with normal distribution. In data that does not comply with normal distribution, the results are median (minimum and maximum) and given as a percentage. The collected data were analyzed using the Pearson Chi-Square test. The odds ratio (OR) was calculated for significant results. Multivariate analysis of independent variables was performed using Logistic Regression analysis and P values ​​\u0026lt;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 356 children admitted to inpatient wards were included in the study. Of the patients 56.5% (n:201) were male and 43.5% (n:155) were female. Median age was 132 (min\u0026thinsp;=\u0026thinsp;6, max\u0026thinsp;=\u0026thinsp;216) months. There was no statistical significance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) regarding the effect of age and gender on parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and need for PICU. However, the type of injury was different between boys and girls. Injuries such as falling objects or slipping were more common in boys (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eConsidering the origins of the patients, 71.6% (n:255) were Turkish, while 28.4% (n:101) were Syrian nationals. When the provinces of the patients were examined, it was seen that most of them came from Hatay, with 91.9% (n: 327), Kahramanmaras followed this with 7.9% (n:28). Of the children, 11.2% (n:40) were admitted in the first 24 hours after the earthquake, 38.5% (n:137) were on the second day, and 44.7% (n:159) were on the third day. It was observed that 5.6% (n:20) were admitted to the hospital after the fourth day. When the chronic diseases of the patients were questioned, it was seen that only 0.9% (n:3) had a chronic disease (Diabetes mellitus etc.), and using medications due to their chronic disease.\u003c/p\u003e \u003cp\u003eOn physical examination, 11.8% (n:42) had signs of dehydration, 15.2% (n:54) had hypothermia or peripheral circulation disorder, and 7% (n:25) had hypotension/shock. Crush was noted in 41 dehydrated patients, 53 patients had hypothermia, and 24 patients had hypotension or shock. It was observed that the average length of stay of the patients was 6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 (median: 4, min\u0026thinsp;=\u0026thinsp;1, max\u0026thinsp;=\u0026thinsp;120) days. The most common injury was being trapped under rubble with 80.3% (n:286). This was followed by slipping with 9.3% (n:33), staying under falling objects with 6.7% (n:24), and falling from a height % of 3 (n:11). Soft tissue injury was present in almost all patients except for one patient. It was observed that the most common injury site was the lower extremities 60.4% (n:215), followed by the upper extremities 33.4% (n:119), head and neck injury in 27.8% (n:99) of children, spine injury in 13.2% (n:47), abdominal injury in 8.4% (n:30), 5.9% (n:21) had thorax injuries, and 4.8% (n:17) had pelvic injuries. Compartment syndrome developed in 31.7% (n:113) of the patients. It was observed that 98.3% (n:350) required a wound care practice and 84.6% (n:301) of the patients required a surgical intervention. Because some patients needed a multidisciplinary approach, they were evaluated by more than one department such as ophthalmology, otolaryngologist, etc. and when the departments of surgery requirement were evaluated, 56.7% (n:202) needed intervention in orthopedics, 42.1% (n:150) plastic surgery, 14.3% (n:51) neurosurgery, 10.4% (n:37) pediatric surgeon. The demographic characteristics of the patients and their clinical outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The type of injury of the patients, the site of injury, and the departments involved in the surgical intervention are demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of the patients and their and their clinical outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value Crush S.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value Fasciotomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value Amputation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;356\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Median)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;216 (132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, n (%),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite, n (%)\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHatay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e327 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKahramanmaraş\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(7,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSanliurfa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSyrian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdmission day after the earthquake, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter day 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDehydration, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypothermia/Shock, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypotension/Shock, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompartment syndrome, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInjury type, injury site, departments involved in a surgical intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;356\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury type, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalling from height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObject falling on\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder the rubble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e286 (80.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlip/Fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury site, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (27.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (33.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (5.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215 (60.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePelvis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepartments involved, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthopedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlastic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150 (42.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWound care unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e350 (98.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVarious bone fractures were detected in 34.3% (n:122) of the patients. 16.6% (n:59) of the fractures were long bone fractures, 7% (n:25) had pelvis fractures, 6.5% (n:23) had vertebral fractures, and 6.2% (n:22) had skull and facial bone fractures. It was observed that 2.8% (n:10) of the patients were amputated. When the children were examined, crush syndrome was detected in 75.3% (n:268) of the patients with a high percentage due to the devastating effect of the earthquake. No statistically significant relationship was found between gender, nationality, presence of chronic disease, and crush syndrome (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Only one patient followed was dead. We observed that there was a significant difference between admission days and crush injuries (P\u0026thinsp;=\u0026thinsp;0.001). Crush injury incidence was higher in patients admitted on the second day or later. In addition, when the relationship between the time the patient was admitted to the hospital and the requirement of fasciotomy was evaluated, a statistically significant difference was present (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), time elapsed increased the probability of fasciotomy requirement. However, no statistically significant relationship was found between the day of admission and amputation (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eCreatine phosphokinase (CPK), myoglobin, kidney function tests (BUN, creatin), and liver function tests (AST, ALT) values were significantly higher in patients with crush injury and fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In those with elevated creatine phosphokinase (CPK), the likelihood of crush injury was found to increase 61 times (OR: 61.66, 95% CI). Moreover, it was determined that elevated CPK increased the risk of fasciotomy by 16.8 times (OR: 16.86, 95% CI). Additionally, there was a significant relationship between elevation of Myoglobin levels and crush injury/fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but elevation of CPK or myoglobin did not affect amputation (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Uric acid values were significantly higher in patients with crush injury (P\u0026thinsp;=\u0026thinsp;0.005). Similarly, the rates of treatment regarding hyperbaric oxygen (HBO), hemodialysis or plasmapheresis, and development of sequelae were significantly higher in patients with crush injury (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Correspondingly, the rates of fasciotomy in patients receiving HBO were found to be highly significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as expected and the need for HBO treatment was high in amputated patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIt was observed that 28.9% (n:103) of patients with crush syndrome required/underwent fasciotomy due to compartment syndrome and a significant relationship was found between crush injury and the need for a fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The likelihood of undergoing a fasciotomy was 26 times higher in patients with crush injury than in those without (OR: 26.00, 95% CI). Sixteen patients with crush syndrome were found to require hemodialysis/plasmapheresis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and patients who underwent these interventions were also associated with fasciotomy (p\u0026thinsp;=\u0026thinsp;0.002). It was determined that there was a strong relationship between dehydration and the development of crush injury and the need for fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). We found that dehydration increased the risk of fasciotomy by 7.2 times (OR: 7.23, 95% CI) and the risk of amputation by 5.4 times (OR: 5.4, %95 CI). Furthermore, hypotension was associated with crush syndrome (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Crush syndrome and the necessity of fasciotomy in children with hypothermia were also statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIt was determined that the average length of stay of the patients was 6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 (median:4, min\u0026thinsp;=\u0026thinsp;1, max\u0026thinsp;=\u0026thinsp;120) days. Of the patients, 41.6% (n: 148) required pediatric intensive care and 112 of the patients with crush were referred to another hospital (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after first aid was given and vital condition stabilized.\u003c/p\u003e \u003cp\u003eAfter the earthquake, the blood gas tests of 91% of the victims (n: 324) were mostly found normal. It was observed that 5.3% (n:19) had metabolic acidosis, 2% (n:7) had metabolic alkalosis, and 1.7% (n:6) had respiratory acidosis. The laboratory test results of earthquake victims according to current reference values performed in the PED of our hospital and their relationship between crush syndrome, fasciotomy, and amputation are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea - The laboratory test results of earthquake victims and their relationship between crush syndrome, fasciotomy and amputation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLow n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNormal n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHigh n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrush Syndrome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFasciotomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAmputation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e203 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e318 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(8,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e319 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e318 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308 (86.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (2,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphorus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnesium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e352 (98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317 (89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e286 (80.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;=\u0026thinsp;0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmylase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyoglobin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e263 (73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb- The laboratory test results of earthquake victims and their relationship between crush syndrome, fasciotomy and amputation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNormal n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHigh n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCrush S.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFasciotomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAmputation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90(25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266(74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT, AST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223(62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN,Kr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e275(77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81(22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCPK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268(75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT, PTT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239(67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was a significant relationship between low Hemoglobin/Hct values (Anemia) and crush syndrome and fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Elevated uric acid levels were detected in 59 of the patients and it was significantly higher in patients with crush injury (P\u0026thinsp;=\u0026thinsp;0.005). Fasciotomy was required in 31 of the patients with high uric acid, and it was observed that fasciotomy was highly required when the uric acid level was high (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and there was a significant relationship between high uric acid and amputation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as well. Elevation of BUN and Creatin was detected in 81 of the patients and elevation of AST/ALT was detected in 223 patients. The development of crush syndrome and the need for fasciotomy were also higher in these patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eUrine analysis was found to be normal in 31.5% (n:112) of the children who could undergo urinanalysis. It was observed that 14.6% (n:52) had hematuria, 1.4% (n:5) had anuria, and 0.3% (n:1) had pyuria.\u003c/p\u003e \u003cp\u003eChest radiography was not performed in 61.8% of the patients (n:220). While the chest radiography of 31.2% (n:111) of the patients was unremarkable, an important finding such as pneumothorax or pleural effusion was detected in 7% (n:25) of the victims. Abdominal ultrasound (USG) was performed in 8.7% (n:31) of the patients and 4.8% (n:17) of the victims had normal findings. On the other hand, the victims appeared to have an injury of their belly and underwent abdominal USG; intra-abdominal fluid or bleeding was detected in 2.6% (n:9), liver/spleen contusion in 1.1% (n:4) patients, and renal/urinary system contusion in 0.3% (n:1) patients.\u003c/p\u003e \u003cp\u003eComputed tomography (CT) was not routinely performed in 18.3% (n:65) of the patients and 47.8% of the CT scans were reported as normal. According to CT scan reports, 10.4% (n:37) of the patients had various bone fractures, 5.9% (n:21) had soft tissue injuries, 5.3% (n:19) had intracranial hemorrhage, 2 patients (0.6%) had diffuse axonal damage, 3.7% (n:13) had serious thorax injuries such as lung contusion, pneumothorax, mediastinum, emphysema and pleural effusion. Of the victims, 1.7% (n:6) had injury/bleeding/hematoma in the internal organs of the abdomen and it was observed that 6.2% (n:22) of the patients had injuries in more than one region of their body. The treatments initiated for the patients, nutritional status, interventional procedures, and clinical outcomes of victims are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatments initiated, nutritional status, interventional procedures and clinical outcomes of victims\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOxygen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParenteral hydration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1/2 isomix solution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e293 (82.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5% Dextrose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1/3 isomix solution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (2,2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOral nutrition (Age specific)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e289 (81.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnteral products\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntibiotics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (89.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHyperbaric oxygen treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTetanus prophylaxis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodialysis/Plasmapheresis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePediatric intensive care admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (41.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferred to another hospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (31.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSequelae status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeath\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we aimed to analyze the experiences and clinical outcomes of children victims admitted to a tertiary research hospital after a sudden earthquake, to improve future preparedness associated with access to essential health services, to strengthen the emergency response system, and to reduce losses in case of a future disaster. This study demonstrated that the gender of the patients were evenly distributed and this was consistent with the literature (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Of the victims, the mean age was \u0026asymp;\u0026thinsp;127 months. A total of 119 patients, \u0026lt;\u0026thinsp;16 years of age (mean 9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 years), were assessed and hospitalized in one of Tehran's hospitals within one week of the Bam earthquake (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Age and gender characteristics vary depending on the nature and inclusion criteria of the studies, and there is no other study showing the age range in children. The number of studies in this field is few, considering the adult age group with limited resources. Therefore, this study conducted comprehensively in the pediatric age group will be the first in the literature. It was observed that age and gender did not affect parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and the need for PICU. As authors we have to state that; even though the region of our hospital is comparatively (273 km) away from the origin of the earthquake, our experiences showed that it was felt with a Richter scale magnitude of more than 6, we have caught it while sleeping and experienced relatively mild but a seriously frightening earthquake with the same scenario. Injuries such as falling objects or slipping were more common in boys than in girls. This might be because boys are more active and energetic than girls and they tended to run to other rooms near family members (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile the majority of the patients were Turkish, approximately one-third were Syrian nationals probably because the patients commonly came from the Hatay district which is nearby Syria and approximately 50% of the total number of Syrians in Turkey live in 11 provinces affected by the earthquake (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In a study conducted after an earthquake, it was reported that 754 of 1582 patients were admitted within the first 24 hours (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, in the Taiwan earthquake, it was reported as 66.2% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and 42% of the patients applied on the first day of an earthquake in our country (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In our study, unlike the literature, we found that most of the patients (44.7%) applied on the 3rd day. This situation can be explained by the difficulty in responding to the debris due to its destructive nature and the difficulty in transportation. Almost all (95%) children were admitted to the hospital during the initial three days. This showed us that government\u0026rsquo;s health response must be urgent and powerful at first 3 days.\u003c/p\u003e \u003cp\u003eThe victims may lose fluid to the third cavities, primarily through the skin, and since fluid intake is not possible, dehydration occurs. Hence, in the early period, almost all patients with rhabdomyolysis are hypovolemic. Since earthquakes happen in winter, severe and prolonged hypothermia may also cause rhabdomyolysis, and bleeding from any cause also contributes to hypovolemia. Outcomes of patients with crush syndrome vary greatly depending on the organ and system it affects. The most common findings are acute renal failure (ARF), hypotension, shock, cardiac and respiratory failure (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similar to the literature, in our study, it was observed that there was a significance in terms of crush syndrome and the need for fasciotomy in dehydrated patients, who had hypotension/shock and hypothermia.\u003c/p\u003e \u003cp\u003eIn our study, the average length of stay of the patients was found to be 6.7 days. The mean length of hospital stay of earthquake victims in Tuth, was equal to 14.7 with a median of ten days, respectively, which was higher than ours. A study in a rural hospital in Nepal showed that earthquake victims had a median length of stay of 8 days. In another study involving admitted victims of the Wenchuan earthquake, their mean length of hospital stay was 7 days, ranging from one to 120 days similar to our study (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In another study, the mean duration of hospitalization was 1.4 days. Twenty-two children (8.2%) were hospitalized for 4 days and the median length of stay was 13 days (range: 1 to 87 days) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The majority of earthquake-related injured patients achieved care during the first 4 weeks of the response. We believe that the difference in days in the studies might be because the severity of the earthquake and the number of patients affected vary according to the different landscapes of various countries. The majority of deaths and injuries during earthquakes occur as a result of being buried under collapsed rubble. Although early fatal injuries generally occur due to the collapse of building stuff, such as columns, beams, walls, etc., a significant portion of those who survived the disaster were injured by household items (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For this reason, to prevent injuries fixing household items to the wall is recommended as a simple but very effective method (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Some earthquake victims jump out of windows of their own free will and are injured due to the impact of the event. It has been reported that the risks of death and injury of earthquake victims are closely related to the floor they live on. Accordingly, those living on the upper floors are exposed to a more serious risk of injury (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It is stated that superficial erosions, penetrating traumas, and/or fractures can be seen in those who fall from lower floors to the ground, whereas fatal blunt or penetrating traumas are more common in those who fall from upper floors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, consistent with the literature, it was observed that the most common type of injury was being trapped under rubble, followed by slipping, falling on an object, and falling from a height. In our study, soft tissue injury was present in almost all patients. When all hospital admissions during the Armenia earthquake were reviewed, soft tissue injuries such as laceration and contusion were the most common (24.9%), followed by head traumas (22%), lower extremity traumas (19%), crush syndrome (11%) and upper extremity traumas (10%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In Southern Italy, approximately half of the disaster victims were injured in more than one part of the body, and the most frequently reported type of injury was laceration (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Reports on the type of injury vary significantly between disasters. The best example of this is the two earthquakes in the USA. Although no head trauma was reported in the Loma Prieta Earthquake, head trauma was reported at a rate of 11.9% in the Northridge earthquake (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In our study, it was observed that many procedures such as soft tissue debridement, repair of skin lacerations, and suturing of wounds were performed bedside under sedation/analgesia in pediatric wards. Similar rates and interventions are available in the literature (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, the frequency of crush injury and fasciotomy was high in patients who were trapped under collapsed rubble. As expected, the earthquake victims required consultation with the Department of Orthopedics mostly. This was similar to the pattern of earthquake injuries reported in the literature (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In another earthquake in our country, 66% of patients admitted to the hospital had extremity injuries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Xiang et al. reported that orthopedic injuries accounted for 81% of all pediatric injuries after the China earthquake (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our study, two-thirds of the patients were treated by the Department of Orthopedics. One-third had various bone fractures. Long bone fractures accounted for more than half of the cases, with the lower extremities being the most common body location. This is in agreement with other studies that reported extremity injuries as the most common types of injuries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In our findings, unlike the literature, it was observed that extremity injuries were followed by head/neck, vertebra, abdomen, thorax, and pelvic injuries respectively. Tanaka et al. reported that less than 7.5% of earthquake victims had head, chest, and abdominal injuries during the Hanshin-Awaji earthquake (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Non -orthopedic injuries such as head, chest, and abdomen are generally more severe and fatal. It is assumed that children with injuries in the form of severe head trauma do not survive the initial trauma. In our study, head traumas were very high percentage 27.8%, unlike the literature. Bulut et al. reported a 7% prevalence of head injuries during post-disaster response in our country (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In studies conducted on earthquake-related head trauma in pediatric patients, Farfel et al. reported 3.2% of head trauma, while Zhao et al. reported 12% of head injuries (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In a recent study conducted in the general population regarding this earthquake, the most common type of injury was head trauma, which was consistent with our study (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The field of pediatrics is still untouched regarding earthquake preparedness and more studies are needed because the distribution of the injuries and care strategies of children differ extremely from adults.\u003c/p\u003e \u003cp\u003eCrush syndrome is one of the most common and fatal clinical manifestations of earthquakes, if not treated quickly. After the Marmara earthquake, the authors stated that crushing injury to a large skeletal muscle mass, sensory and motor disorders in the extremities, myoglobinuria and/or hematuria, and serum CPK levels\u0026thinsp;\u0026gt;\u0026thinsp;1000 U/L were the diagnostic criteria for crush syndrome in the children they followed (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Causes of death included hypovolemic shock, hyperkalemia, hypocalcemia, metabolic acidosis, myoglobinuria, compartment syndrome, and ARF (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). After the Armenian earthquake, 600 crush syndrome cases were reported (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)and 372 cases were reported after the Hanshin-Awaji earthquake which they used serum CPK concentration as an indicator of muscle damage (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The number of studies in this field is few, considering the adult age group with limited resources. In our study, 268 children had crush syndrome (75.3%), which was a very high rate among the entire hospitalized patient population. During the Kobe earthquake; they found a close relationship between crush syndrome and serum myoglobin or serum CPK concentrations (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Similarly, CPK, myoglobin, BUN, Cr and ALT, AST values were quite high in patients with crush injury (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In our study, for those with elevated CPK, we have found the likelihood of crush injury to increase 61 times. Elevated CPK and myoglobin were also associated with crush injury and fasciotomy, and elevated CK increased the risk of fasciotomy by 16 times. Our clinical experience; showed that the increase in serum myoglobin and CPK levels can be used as an indicator of the severity of muscle damage of children victims to predict crush injury and to apply early fasciotomy to prevent amputations.\u003c/p\u003e \u003cp\u003eIt was observed that compartment syndrome developed in 31.7% (n\u0026thinsp;=\u0026thinsp;113) of cases with crush injury and fasciotomy was performed in 28.9% (103 cases). This figure was found to be similar to some publications in the literature (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The need for hyperbaric oxygen, hemodialysis, or plasmapheresis treatment was significantly higher in patients with crush injuries. Another study showed that fasciotomy was required in only 13.1% of patients with crush syndrome (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The fact that there is a significant relationship between crush injury and the need for fasciotomy (crush injury increased fasciotomy incidence by 26 times) and the high rate of fasciotomy may be due to the high number of crush cases we had. When the relationship between the time elapsed after the earthquake until the patient was admitted to the hospital and the development of crush syndrome/fasciotomy was evaluated, it was determined that the later the arrival, the more crush developed and fasciotomy was performed. On the contrary, there was no relationship between admission time and amputation. We interpret this as meaning that amputation of the extremity was probably prevented by rapid fasciotomy and effective treatments.\u003c/p\u003e \u003cp\u003eThe need for HBO was significant in patients who developed crush injuries and underwent fasciotomy. Dehydration was also associated with fasciotomy rates, and it increased the risk of fasciotomy by 7.2 times. The development of crush syndrome and fasciotomy requirement increased in children experiencing hypotension and hypothermia. There are large differences in amputation rates in patients with crush syndrome in the literature. Guidelines recommend amputation to be performed if saving a limb is not possible or if injuries to the limb would cause sepsis or uncontrollable bleeding (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In an earthquake in our country, \u0026asymp;\u0026thinsp;15% of the victims underwent amputation (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Although amputation was performed in 6 out of 202 cases (2.9%) in Kobe (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), above-knee amputations were performed in 4 out of 15 patients (26.6%) in Armenia (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). After the Hanshin-Awaji earthquake, it was reported that 6 of 317 patients underwent primary amputation and 70 underwent fasciotomy (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In a short study of earthquake victims of all age groups, amputation was reported in 7 cases. In our study, only 2.8% (10 cases) of the patients were amputated, which was lower than the literature (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It was observed that none of them underwent primary amputation, and 10 of the patients with crush syndrome underwent secondary amputation. We think that the reason for our low amputation rate is that; since an extraordinary circumstance developed, our tertiary PICU intervened by increasing its capacity by 4 times and as a result, successful case management was achieved and timely effective interventions prevented amputation of the extremity of vulnerable children.\u003c/p\u003e \u003cp\u003eCrush injury and fasciotomy were more common and the risk of amputation increased 5.4 times in dehydrated patients. Therefore, it is very important to hydrate the child early and it is also recommended in the literature to start intravenous fluid therapy before admission to the hospital and even during extraction from the rubble (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study examining patients with crush injury, the need for surgical intervention was less and complications that may occur during the treatment of crush syndrome were low in the group receiving HBO treatment (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). After two earthquakes in our country, HBO treatment was applied to 28 patients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and 24 of the patients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In our study, it was applied to 28 patients, and the rate of HBO treatment was high in amputated patients. The reason for this might be that severe patients in poor general condition went to HBO treatment and therefore their need for amputation was significant.\u003c/p\u003e \u003cp\u003eIn a study, 477 (9.0%) of 5302 patients hospitalized needed dialysis support (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In another study 33 patients were admitted during the earthquake, they detected crush injuries in 15 cases and ARF developed in 10 of them. They reported that two patients required hemodialysis despite aggressive fluid treatments. They stated that since ARF is only seen in children with crush syndrome, it was the main cause of ARF in pediatric patients trapped under rubble (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In another study conducted, 14 (67%) of the patients who underwent fasciotomy had ARF, and 11 of these were treated by hemodialysis (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Again, in the Wenchuan Earthquake, ARF occurred in 62 (41.6%) of a total of 149 patients with crush syndrome, and 33 of them received hemodialysis (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In a preliminary study about the 2023 Maraş earthquake, 4 of the surviving children were treated with hemodialysis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In our study, patients who underwent hemodialysis/plasmapheresis were associated with fasciotomy, and 16 of the patients with crushes needed these interventions. There was no amputation in any of the patients. We think these results show that our treatments were effective.\u003c/p\u003e \u003cp\u003eIn a recent study of the 2023 earthquake, it was observed that 57.3% (35 cases) of 61 surviving children required PICU (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similarly in our study, 41.6% of the patients were found to require PICU care. In another local study of the 2023 Maraş earthquake, the rate of admission to pediatric intensive care was 0.3% (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Once more, in a study investigating the frequency and mortality rate of post-traumatic ARF in children, it was observed that one-quarter of the victims developed ARF, and more care should be taken in the management of traumatized children, especially those who were taken to PICU.\u003c/p\u003e \u003cp\u003eWhen the blood gas results of the cases after the earthquake were examined, it was seen that 5.3% had metabolic acidosis, 2% had metabolic alkalosis, and 1.7% had respiratory acidosis. Our study is very comprehensive in this regard and no publication has been found in the literature about this context to make a comparison. Anemia is a common finding in earthquakes due to many reasons such as bleeding due to trauma or surgical interventions (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It has been reported that anemia was the most common laboratory finding in patients monitored after the Mexico earthquake (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). It is vital to keep the blood Hemoglobin/Hct level within certain limits to ensure tissue oxygenation and perfusion in earthquake victims. Therefore, it is recommended to measure Complete blood count (CBC) as a screening test in critically ill patients to determine the prognosis (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In our study, similar to the literature, low hemoglobin, and Hct values were observed in 38% of the patients. This can be explained by blood loss due to trauma when we consider the serious impact of the earthquake. In contrast, 8% of patients had high Hct values at the time of admission. It has already been known that high hematocrit levels can be observed in patients during an earthquake because of hemoconcentration due to dehydration (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The frequency of anemia was also noted in the blood counts of victims with Crush syndrome during the Marmara earthquake (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In our study, we found that children with low Hb/Hct were prone to crush syndrome and the need for fasciotomy was greater.\u003c/p\u003e \u003cp\u003eRhabdomyolysis is a common complication in patients with crush injuries, and a CPK level elevating more than five times above normal or a value of \u0026gt;\u0026thinsp;1,000 U/L is used to diagnose this condition (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). In a study serum CPK levels were found to be high in all patients (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). We found that the CPK value was high in 75.3% of the patients, similar to the literature. Serum myoglobin level has not been determined in patients after the earthquake in our country and has not been used for diagnostic purposes due to its short half-life and the need for special techniques for measurement. In our study, elevated Myoglobin levels were detected in 263 (73.9%) patients. As authors, we were not sure whether this data was meaningful, but still, the studies on these subjects are very valuable, so we wanted to share our data with you. Additionally, liver enzymes such as ALT and AST increase after rhabdomyolysis (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). In our study, this elevation was detected in 205 patients, and in line with the literature, the development of crush syndrome and the need for fasciotomy were found to be significantly higher in these patients. In a study investigating the prevalence of post-traumatic acute kidney injury (AKI) in children victims, the prevalence was found to be 24.6% (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). In our study, the elevation of BUN and Creatin was detected in 81 of the patients, and crush syndrome and the need for fasciotomy were significant in these patients. Hyperuricemia is very common in ARF due to rhabdomyolysis (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). The serum uric acid level of these patients increases disproportionately with their renal functions (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Similar to the literature, high Uric acid levels were detected in 59 of the patients and it was found to be higher in patients with crush injury. Fasciotomy was required in 31 of the patients with high uric acid levels, and it was observed that this increase was associated with amputation. As the authors, we recommend being careful with high BUN, Cr, ALT, AST, and uric acid levels and following up with the victim more closely. Half of the patients underwent urinalysis, and results were unremarkable in 32% of them. Hematuria was observed in 15% (52 cases), anuria was observed in 1.4% (5 cases), and pyuria was observed in one case.\u003c/p\u003e \u003cp\u003eIn pediatric trauma cases, X-rays, USG, and CT scans are used to detect damage quickly (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). The most common lung injuries in children during earthquakes are; lung contusion, pneumothorax, and hemothorax. Sometimes, although plain radiographs seem to be normal, parenchymal injury and contusion areas can be detected in thorax CT images (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). In our study, 31% of those who had chest X-ray was normal, but an important finding such as; pneumothorax or pleural effusion was detected in 7% (25 cases). In a study conducted to evaluate the role of USG in diagnosis among earthquake victims, Fayyaz et al. found that it has an important diagnostic value in natural disasters. In addition, Thorax USG was useful in detecting intraperitoneal fluid and free air, suggesting the level of organ injury, and retroperitoneal injuries and deciding on conventional treatment (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). In a study conducted after the earthquake in Lu-Shan city, massive fluid in the abdomen resulting from liver and spleen injury was detected in 8 of 38 patients who underwent abdominal USG. Pericardial effusion was detected in 1 patient, pneumothorax in 2 patients, massive pleural effusion in 1 patient, and collapse of the inferior vena cava was detected in 9 patients (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). In our study, 5% of the patients (17 cases) had normal abdominal USG findings. On the other hand, free intra-abdominal fluid or intra-abdominal bleeding was detected in 2.6% of the patients (9 cases), while 4 patients had liver/spleen contusion and one patient had renal/urinary system injury.\u003c/p\u003e \u003cp\u003eSince the type of injury in pediatric earthquake victims is different from that in adults, CT imaging provides rapid diagnosis shortening the time to start life-saving treatments (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). CT is a valuable diagnostic tool for detecting head, chest, spine, abdominal and pelvic injuries (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). At the 2023 Maraş earthquake, the most common injuries were head trauma (18.7%), followed by thoracic injury (15.6%), spinal injury (8.5%), pelvic fracture (7.4%), abdominal injury (3.9%), and maxillofacial fracture (2.3%). Moreover, pulmonary contusion was the most common CT finding among earthquake-related thoracic injuries (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). While half of the CT scans taken were interpreted as normal, 10.4% (37 cases) showed various bone fractures, 6% (21 cases) showed soft tissue injury, 5.3% (19 cases) showed intracranial hemorrhage, 4 (13 cases) had serious thorax injuries such as lung contusion, pneumothorax, emphysema, pleural effusion, and 2% (6 cases) had injury/bleeding/hematoma in the internal organs in the abdomen. Our patients rescued from the rubble were first rehydrated and hemodynamically stabilized with intravenous fluid therapy. Early fluid therapy is vital to minimize the risk of AKI due to crush syndrome. We found that 82.3% of the children was hydrated with \u0026frac12; isomix solution which was most similar solution in terms of content to isotonic solutions with appropriate potassium chloride and dextrose recommended by The American Academy of Pediatrics to decrease the risk of developing hyponatremia. However, 15.4% was hydrated with %5 Dextrose solution and 2.2% was with 1/3 isomix solution. The reason for this mistake might be because first rescue responders were not specialist of pediatrics. It is necessary to provide training and support to rescue teams regarding hydration solutions with appropriate content. Data obtained from children after an earthquake showed that AKI did not occur in patients who started early fluid therapy (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Similarly, studies conducted during the BAM earthquake in Iran have shown that early intravenous volume replacement prevents both ARF and the need for dialysis in children (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInfections are also one of the most common factors contributing to mortality in trauma patients which wound infections are mostly encountered. It may occur in the early period with the deterioration of skin integrity due to trauma, the presence of necrotic tissue, or in the late period with surgical or invasive interventions (amputation, debridement, fasciotomy, exploration) performed in intensive care units (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). In our study, almost all patients received intravenous systemic antibacterial drugs, especially Ampicillin-Sulbactam similar to the literature (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In addition, all victims were vaccinated regardless of their vaccination status, considering the possibility of tetanus. It is known that prophylaxis measures must be taken by implementing similar approaches in previous disaster situations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). As authors, we are aware of the limitations of the manuscript related to its single-centered and retrospective design. However, the strength of our article is that there is no such comprehensive study about children regarding emergency health services and clinical outcomes among disaster victims. Therefore, it was difficult to access some data in the discussion. Since our hospital was at a close location near the earthquake, it has quadrupled its capacity in this emergency condition, by the way we have accessed the data of a large number of pediatric patients.\u003c/p\u003e \u003cp\u003eTo accommodate rapid patient circulation, a central triage system was established in our hospital, taking into account the patients' ages, general conditions, and medical problems. Such organizations still have challenges as solutions need to be found urgently. This issue was touched upon in a study conducted in China and the difficulties of efficient triage after the earthquake were discussed (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The initial approach should be to prevent damage and complications that may occur gradually with non-surgical treatments and be ready to proceed with a surgical procedure immediately if necessary. We, as a pediatrics team in a tertiary research hospital setting, had the privilege to assist injured and sick children affected by this sudden unexpected disaster. Therefore, we wish to share our experiences with our colleagues worldwide. Countries must be prepared in case of natural disasters and must have trained health professionals, auxiliary health personnel, and adequate equipment. We need to learn more about medical response and procedures for children and enhance the development of efficient algorithms and procedures for better preparedness for sudden disasters.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eA major earthquake is a destructive event that creates a chaotic situation. Dehydration, hypotension and shock was related to crush injury and the need for fasciotomy. Compartment syndrome and bone fractures may develop in one third of the children. Anemia and biochemical parameters must be followed and elevated CPK, myoglobin and uric acid levels are highly associated with fasciotomy and amputation. Therefore, for the development of preparedness and recovery policies for future disasters the clinical outcomes of children is crucial and treatments like fasciotomy, hyperbaric oxygen, hemodialysis/plasmapheresis must be administered timely to prevent amputation and development of sequelae. Early intervention should be carried out by a good medical team supported by strong logistic aid systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Source:\u003c/strong\u003e \u003cem\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFinancial interest:\u003c/strong\u003e\u003c/em\u003e \u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Statement\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest relevant to this article to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eŞefika Aldaş; had primary responsibility for protocol development, patient screening, enrollment, outcome assessment, preliminary data analysis and writing the manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMurat Ersoy, Ali Tun\u0026ccedil;, Esra Vatansever, Suna Ozdem \u0026nbsp; had primary responsibility for protocol development, outcome assessment.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGamze G\u0026ouml;kulu, Fatma Sercan Aynacı, Banu Katlan; had primary responsibility for protocol development, patient screening, enrollment.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMehtap Durukan Tosun, Berfin Ozg\u0026ouml;k\u0026ccedil;e Ozmen; participated in the development of the protocol and analytical framework for the study.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSanliay Sahin; supervised the design and execution of the study, reviewed and revised the manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll authors contributed to the study conception and design and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Toros University\u003c/em\u003e with registration number DEISC-PR-26.04.2023/46.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003cem\u003eInformed consent was obtained from all individual participants included in the study.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBulut M, Fedakar R, Akkose S, Akgoz S, Ozguc H, Tokyay R. Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emergency medicine journal. 2005;22(7):494-8.\u003c/li\u003e\n\u003cli\u003eWannous C, Velasquez G, editors. 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Prehospital and disaster medicine. 2009;24(6):493-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"amputation, child, crush syndrome, disaster, earthquake, fasciotomy, pediatric emergency care","lastPublishedDoi":"10.21203/rs.3.rs-3807964/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3807964/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eLarge-scale, sudden-onset natural disasters occur unexpectedly, causing widespread destruction, resulting in injuries and deaths. It is extremely important to determine the clinical profile of vulnerable child victims admitted in emergencies and the characteristics that are associated with the hospital stay. Therefore, we aimed to analyze the experiences of children admitted to a tertiary hospital to improve future preparedness in case of a sudden disaster.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 356 children who were referred from the pediatric emergency department (PED) were included in the study. All patients were subjected to medical history, vital signs, state of hydration, pulse oximetry, physical examination, and routine laboratory tests. Chest X-ray, abdominal ultrasound, and Computed tomography were also documented. Demographics and physical examination findings, duration of hospitalization, surgical interventions, concomitant complications, and presence of life-threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Medications and additional treatments like hemodialysis, and hyperbaric oxygen and the outcomes were also recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the patients, 56.5% were male and median age was 132 months. There was no statistical significance regarding the effect of age and gender on parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and need for PICU. Injuries such as falling objects/slipping were more common in boys (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Of the children, only 11.2% were admitted in the first 24 hours and 44.7% were admitted on the third day. 11.8% (n:42) had signs of dehydration, 15.2% had hypothermia and 7% had hypotension/shock. Crush was noted in 41 dehydrated patients, 53 patients having hypothermia, and 24 patients with hypotension/shock. The average length of hospital stay was 6.7 days. The most common injury was being trapped under rubble with 80.3% and the most common injury site was lower extremities at 60.4%. Compartment syndrome developed in 31.7% of the patients, bone fractures were detected in 34.3% of the patients and 2.8% (n:10) of the patients were amputated. Crush syndrome was detected in 75.3% of the patients, and the incidence was higher in patients admitted on the second day or later and the requirement of fasciotomy increased. Elevated creatine phosphokinase (CPK), increased crush injury 61 times and fasciotomy by 16.8 times, Also, elevation of Myoglobin and Uric acid levels were higher in patients with crush injury (P\u0026thinsp;=\u0026thinsp;0.005). Of patients with crush syndrome, 28.9% (n:103) required/underwent fasciotomy due to compartment syndrome, and a significant relationship was found between crush injury and the need for fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The likelihood of fasciotomy was 26 times higher in crush injury. There was a strong relationship between dehydration and the development of crush injury and the need for fasciotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Anemia, elevated uric acid, BUN and Creatin, and AST/ALT levels and development of crush syndrome and the need for fasciotomy/amputation were higher (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDehydration, and hypotension/shock were related to crush injury and fasciotomy. Compartment syndrome and bone fractures may develop in one-third of the children. Anemia and elevated biochemical laboratory parameters must be followed and elevated CPK, myoglobin, and uric acid levels are highly associated with fasciotomy and amputation. Therefore, for the development of preparedness, response, and recovery policies for future disasters the clinical outcomes of children are crucial and treatments like fasciotomy, hyperbaric oxygen, and hemodialysis/plasmapheresis must be administered timely to prevent amputation and development of sequelae.\u003c/p\u003e","manuscriptTitle":"Disaster of the Century, 2023 Earthquake of Turkey: How Can We Prevent Amputation of Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-05 09:51:14","doi":"10.21203/rs.3.rs-3807964/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1000e250-27e6-45b9-bc13-b025db389462","owner":[],"postedDate":"January 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-05T15:29:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-05 09:51:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3807964","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3807964","identity":"rs-3807964","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}