What question did this study set out to answer?

This review aimed to consolidate evidence on crush syndrome's epidemiology, management, and outcomes in earthquake casualties.

April 4, 2026Open Access

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

Puntos clave

This review aimed to consolidate evidence on crush syndrome's epidemiology, management, and outcomes in earthquake casualties.
Conducted systematic review according to PRISMA guidelines.
Searched electronic databases for observational studies on earthquake casualties with crush syndrome.
Pooled data using random-effects meta-analysis for various outcomes including mortality and acute kidney injury.
Included fifty studies primarily from Turkey, Iran, and China.
Pooled proportion of patients requiring dialysis was 49%.
Overall pooled mortality was 8%, with regional variation observed.
Acute kidney injury was reported as the most frequent complication at 49%.

Resumen

Abstract Background Crush syndrome is a life-threatening systemic complication of traumatic rhabdomyolysis and a leading cause of morbidity and mortality following earthquakes. Despite its clinical significance, a comprehensive synthesis of its global epidemiology, management, and outcomes is lacking. This systematic review and meta-analysis aimed to consolidate the evidence on CS in earthquake victims. Methods We conducted a systematic review in accordance with PRISMA guidelines (PROSPERO: CRD420251177534). Electronic databases (PubMed/MEDLINE, Web of Science, CINAHL) were searched from inception through January 2024 for observational studies of earthquake casualties with CS. Outcomes included mortality, dialysis requirement, acute kidney injury (AKI), and other complications. Data were pooled using random-effects meta-analysis. Results Fifty studies (1988–2023), primarily from Turkey, Iran, and China, were included. Substantial heterogeneity was observed, largely due to inconsistent definitions of CS. The pooled proportion of patients requiring dialysis was 0.49 (95% CI 0.40–0.58; I²=96.95%, 38 studies). The overall pooled mortality was 0.08 (95% CI 0.06–0.10; I²=93.0%, 39 studies), with significant regional variation (1% to 26%). AKI was the most frequent complication (pooled proportion 0.49; 95% CI 0.38–0.59). Marked creatine kinase elevation and metabolic derangements were consistently reported. Conclusions CS following earthquakes carries a high burden of renal failure, with nearly half of affected patients requiring dialysis. Mortality is significant and influenced by geographic context and response capabilities. The profound heterogeneity in definitions and reported outcomes underscores an urgent need for standardized diagnostic criteria. Preparedness planning must prioritize early volume resuscitation, surge capacity for renal replacement therapy, and the development of context-adapted, evidence-based clinical guidelines.

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