Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake

Objective: To clarify clinical features and determine the severity of injuries in patients with crush syndrome in Hansin-Awaji earthquake. Methods: We retrospectively reviewed medical records of 6,107 patients hospitalized in 95 hospitals, and identified 372 patients with crush syndrome. Results: The major sites of crush injury were in the lower extremities (74%), followed by the upper extremities (10%), and the trunk (9%). Pelvic fractures, limb fractures, and abdominal injuries were the most frequently associated injury. Patients with trunk compression and/or with abdominal injury had a higher mortality rate. A total of 50 patients (13.4%) died. The causes of death within 5 days after the earthquake were hypovolemia and hyperkalemia. Peak serum creatine kinase concentration increased with the number of crushed extremities. Mortality and the risk of acute renal failure were higher in patients with creatine kinase concentration more than 75,000 mu/L. Conclusions: Peak serum concentration of creatine kinase as well as the number of injured extremities serve to estimate the severity of crash syndrome.