Silent threat: The deadly face of acute respiratory symptoms in earthquake survivors

Abstract

OBJECTIVE: This study aims to evaluate the underlying causes and clinical outcomes of acute respiratory symptoms in critically ill pediatric patients who survived the February 6, 2023, earthquake and were admitted to the pediatric intensive care unit (PICU) of a designated disaster hospital.

METHODS: This retrospective, longitudinal observational study included pediatric patients aged 1 month to 18 years admitted to the PICU of Mersin City Training and Research Hospital due to respiratory symptoms following the earthquake. Clinical, radiological, and laboratory data and treatment outcomes were analyzed. Ethics committee approval was obtained from the Toros University. Group comparisons were made between patients with and without respiratory involvement. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for key associations.

RESULTS: Of 140 children, 48 (34.3%) had respiratory involvement (mean age: 10.2 ± 5.2 years, 54.2% of males, and 67% admitted within 72 h). Major etiologies were chest trauma (41.7%), acute kidney injury related pulmonary edema (14.6%), combined chest trauma + acute kidney injury (27.1%), and neurological causes (10.4%); infections (4.2%) and allergic reactions (2.1%) were less common. Respiratory support was needed in 19 (39.6%) patients. Respiratory involvement correlated with multisystem trauma (63% vs. 11%, P < 0.001), chest trauma (69% vs. 0%, P < 0.001), and acute kidney injury (50% vs. 32%, P = 0.048). PICU stay was longer (2.9 ± 2.2 vs. 2.2 ± 1.4 days, P = 0.014), while mortality was low (2% vs. 0%, P = 0.740). In multivariable analysis, acute kidney injury (OR: 5.2, 95% CI: 2.0–13.1, P < 0.001) and central nervous system injury (OR: 3.1, 95% CI: 1.2–8.0, P = 0.018) independently predicted respiratory involvement.

CONCLUSION: In pediatric earthquake survivors, respiratory symptoms often indicate multisystem involvement. Beyond chest trauma, acute kidney injury and neurological causes are major contributors to respiratory compromise. A comprehensive, integrative approach is essential for timely diagnosis and intervention.

How to cite this article: Katlan B, Çayan ÖK, Topdemir M, Kızıldağ İ, Korkmaz Ü. Silent threat: The deadly face of acute respiratory symptoms in earthquake survivors. Turk J Emerg Med 2026;26:102-9.

Ethical approval was obtained from the Ethics Committee of Toros University (Approval No.: 2023/0142, Date: March 10, 2023).

•  BK: Conceptualization (lead), investigation (lead), writing – original draft (lead), writing – review and editing (equal), and formal analysis (lead)
•  ÖKÇ: Writing – review and editing (equal) and methodology (supporting)
•  MT: Data curation, resources, and writing – review and editing
•  İK: Data curation and writing – review and editing
•  ÜK: Supervision, project administration, and writing – review and editing.

None Declared.

None.

We thank the nursing staff of the pediatric intensive care unit for their invaluable support during the study period.