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

Published online by Cambridge University Press:  04 October 2023

Sarper Yılmaz Open the ORCID record for Sarper Yılmaz [Opens in a new window] ,
Remzi Cetinkaya Open the ORCID record for Remzi Cetinkaya [Opens in a new window] ,
Mehmet Ozel Open the ORCID record for Mehmet Ozel [Opens in a new window] ,
Ali Cankut Tatliparmak Open the ORCID record for Ali Cankut Tatliparmak [Opens in a new window]  and
Rohat Ak Open the ORCID record for Rohat Ak [Opens in a new window]
Sarper Yılmaz*
Affiliation:
University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey; Secretary of the Disaster Commission of the Turkish Emergency Medicine Association, Ankara, Turkey
Remzi Cetinkaya
Affiliation:
University of Health Sciences, Dept. of Emergency Medicine, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
Mehmet Ozel
Affiliation:
University of Health Sciences, Dept. of Emergency Medicine, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
Ali Cankut Tatliparmak
Affiliation:
Uskudar University Faculty of Medicine, Dept. of Emergency Medicine, Istanbul, Turkey
Rohat Ak
Affiliation:
University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
*
Correspondence: Sarper Yılmaz, MD Department of Emergency Medicine University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital Kartal, Istanbul, Turkey Secretary of the Disaster Commission of the Turkish Emergency Medicine Association Ankara, Turkey E-mail: [email protected]
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Abstract

Objectives:

Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis.

Methods:

A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis.

Results:

The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%.

Conclusions:

The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.

Keywords

acute kidney injurydialysisdisaster managementearthquake-related injuriesscoring systems
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 6 , December 2023 , pp. 716 - 724
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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