Evaluation of critical parameters for optimizing the therapeutic approach in pediatric patients with compartment syndrome during the 2023 Türkiye earthquake disaster.

Abstract

Background: The 2023 Türkiye earthquake resulted in a large number of pediatric victims with musculoskeletal trauma, many of whom developed compartment syndrome (CS) and crush-related complications. This study aimed to identify clinical and biochemical parameters associated with disease severity, renal failure, and limb loss in children affected by the disaster.

Methods: A retrospective analysis was conducted on 103 pediatric patients (0-18 years) admitted after the earthquake. Demographic data, duration of entrapment, laboratory values (creatine kinase [CK], myoglobin, aspartate aminotransferase [AST], alanine aminotransferase [ALT], urea, potassium), and therapeutic interventions (fasciotomy, negative-pressure wound therapy [NPWT], hyperbaric oxygen therapy [HBOT], hemodialysis, and amputation) were evaluated. Receiver operating characteristic (ROC) analyses were used to determine cut-off values predicting adverse outcomes.

Results: Forty-seven patients (45.6%) developed compartment syndrome involving 68 limbs and underwent fasciotomy. Thirteen patients (12.6%) required limb amputation, and 19 (18.4%) underwent hemodialysis due to acute kidney injury. An entrapment duration exceeding 8 hours (area under the curve [AUC]=0.84, p<0.001), CK>10,000 U/L, and myoglobin >4,000 ng/mL were independent predictors of renal failure, fasciotomy, and amputation. NPWT was applied in 66% and HBOT in 85% of patients with necrosis, contributing to an 82% limb salvage rate. No amputations occurred in patients without persistent necrosis. Three patients (2.9%) died from severe crush-related injuries and multi-organ failure.

Conclusion: Prolonged entrapment and markedly elevated CK and myoglobin levels are reliable indicators of adverse outcomes in pediatric earthquake victims with compartment syndrome. Early recognition, timely decompression, and structured wound management (NPWT and HBOT) are essential for improving survival and limb salvage when early surgical intervention is not feasible in large-scale disasters.