Crush injury syndrome in earthquakes: a systematic review and meta-analysis on its frequency and complications.

Quick Take: This systematic review and meta-analysis quantifies the substantial morbidity associated with crush injury syndrome in earthquake victims, directly impacting resource allocation and preparedness.

💡 Clinical Impact

• Mechanistic Why: Prolonged skeletal muscle ischemia and subsequent reperfusion injury trigger a systemic inflammatory cascade and release of myoglobin, leading to acute kidney injury, rhabdomyolysis, and hyperkalemia.
• Clinical/Systemic Benefit: Understanding the high frequency (64-90%) and significant complication rates (27-58% for AKI, 5-21% for limb amputation) informs pre-hospital triage, emergency department protocols, and critical care surge capacity planning.

📊 Evidence Breakdown Evidence Grade: 🟡 7/10 (Systematic Review with substantial heterogeneity)

Analysis: This meta-analysis synthesizes existing literature on crush injury syndrome from earthquakes, confirming a high incidence of the condition and a notable burden of complications. However, considerable heterogeneity across the included studies, likely due to variations in reporting, patient populations, and the definition of "crush injury," limits the precision of the pooled estimates and raises questions about generalizability.

Note: The data primarily reflects acute outcomes. Long-term sequelae, such as chronic pain and functional disability, are not comprehensively addressed.

🩺 Practice Recommendation [Early Signal]: Alert trauma and critical care teams to the high probability of crush injuries and associated complications in the event of a significant earthquake.

• Monday Morning Action: Review existing disaster preparedness plans for specific protocols addressing mass casualty incidents involving crush injuries, including fluid resuscitation strategies, electrolyte monitoring, and emergent nephrology/neurosurgery consultations.

https://link.springer.com/article/10.1186/s12873-026-01516-9