Early ICU Transfer and Trauma Severity may predict Dialysis Dependence in kids with Earthquake-Related Crush Injury: JAMA
NBMCH Super Specialty Block
A new study published in JAMA Network Open has found that among children affected by the crush syndrome due to the 2023 Kahramanmaraş earthquake in Turkey, late transfers to the intensive care unit (ICU) or a high Pediatric Trauma Score increased the chance of discharge dependency on dialysis. The study was conducted by Demet D. and colleagues.
A total of 183 pediatric patients admitted with earthquake-related injuries were studied, whose median age was 158 months (range: 108-192 months) and 54.4% were male. Of them, 90 children needed kidney replacement therapy (KRT). The rubble stay duration was as long as 25.7 hours with a range from 1 to 137 hours. At admission, 56.6% of patients had stage 3 acute kidney injury (AKI), as per the Kidney Disease—Improving Global Outcomes (KDIGO) classification, with a median serum creatinine phosphokinase (CPK) level of 15,555 IU/L.
Patients underwent different KRT modalities, including continuous venovenous hemodiafiltration (CVVHDF) (36.7%) and intermittent hemodialysis (IHD) (25.6%). The primary outcome assessed was dialysis dependence at discharge, while secondary outcomes included the length of ICU stay.
Key Findings
Of all the KRT-treated patients, 33 (36.7%) received CVVHDF, and 23 (25.6%) IHD.
The median serum CPK level in these patients at admission was 15,555 IU/L; IQR: 9,386-59,274 IU/L.
Serum CPK levels of the KDIGO stage were highly associated with those on admission (AUC: 0.750; 95% CI: 0.621-0.879; p<0.001).
IHD was the only independent factor that was associated with having a shorter LOS in the PICU (OR: 6.87; 95% CI: 1.54-30.67; p=0.01).
Dialysis dependency at discharge was more frequent in children who were transferred late to the ICU (β = 0.003; 95% CI: 0.001-0.005; p<0.001) and those with a high Pediatric Trauma Score (β = 0.022; 95% CI: 0.003-0.041; p=0.02).
The overall mortality rate in the cohort was 6.6% (6 patients).
Researchers concluded that children with crush syndrome due to earthquake-related injuries had a significantly higher risk of dialysis dependency at discharge when transferred late to the ICU or presented with a high Pediatric Trauma Score. The results placed emphasis on early critical care management and targeted therapeutic interventions aimed at improving outcomes in pediatric AKI cases resulting from entrapment during natural disasters.
Reference:
Demirkol D, Besci T, Havan M, et al. Kidney Replacement Therapies and Outcomes in Children With Crush Syndrome–Associated Kidney Injury. JAMA Netw Open. 2025;8(1):e2456793. doi:10.1001/jamanetworkopen.2024.56793
