External validation and comparison of SAFE QUAKE and dialysis score in earthquake related crush injuries

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dc.authorid0000-0002-6729-5021
dc.authorid0000-0003-4839-8110
dc.authorid0000-0002-8509-0660
dc.authorid0000-0001-8166-659X
dc.authorid0000-0001-8662-0670
dc.authorid0000-0002-2529-8064
dc.contributor.authorAlpar, Suleyman
dc.contributor.authorYilmaz, Sarper
dc.contributor.authorBuyurgan, Cagri Safa
dc.contributor.authorYarkac, Akif
dc.contributor.authorSuzer, Neslihan Ergun
dc.contributor.authorTatliparmak, Ali Cankut
dc.date.accessioned2026-01-31T15:08:46Z
dc.date.available2026-01-31T15:08:46Z
dc.date.issued2025
dc.departmentİstanbul Beykent Üniversitesi
dc.description.abstractBackgroundThis study aimed to compare the predictive accuracy of two scoring systems-Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement (SAFE-QUAKE) and the Dialysis Score-developed to assess the need for dialysis in patients with crush injuries admitted to the emergency department (ED) following the February 6 T & uuml;rkiye earthquakes.MethodsIn this retrospective observational study, the performance of the SAFE-QUAKE and Dialysis Score systems were evaluated using data from a university hospital that was independent from the centers where these scores were originally developed. The study included patients admitted to the ED after the same earthquakes.ResultsThe SAFE-QUAKE score demonstrated a higher negative predictive value (NPV) for ruling out dialysis (93.4%), whereas the Dialysis Score had superior positive predictive value (PPV) (71.0%). Although the area under the receiver operating characteristic curve (AUROC) was higher for SAFE-QUAKE [0.894 (95% CI: 0.831-0.957)] than for the Dialysis Score [0.836 (95% CI: 0.738-0.934)], this difference was not statistically significant (Z = 1.415; p = 0.157). According to the Net Reclassification Index (NRI), SAFE-QUAKE provided a clear advantage in correctly reclassifying non-dialysis patients to a lower-risk category [NRI- = 0.491 (95% CI: 0.321-0.643)], correctly downgrading 74.5% of such patients while misclassifying only 25.5%. Across various hypothetical prevalence rates, SAFE-QUAKE consistently provided higher NPVs (e.g., 98.9% at 5% prevalence), while the Dialysis Score maintained higher PPVs (e.g., 28% at 5% prevalence; 88.0% at 50% prevalence).ConclusionFollowing catastrophic disasters such as the February 6 T & uuml;rkiye earthquakes, the capacity of healthcare facilities to provide dialysis becomes a key factor in ED decision-making. When patients are to be transferred to facilities without dialysis capabilities, triage based on the SAFE-QUAKE score can help safely identify those at low risk for dialysis. Conversely, if the receiving center has dialysis capacity, the Dialysis Score can be used to prioritize patients more likely to require dialysis. The sequential use of both scores may enhance triage accuracy by prioritizing SAFE-QUAKE for rapid ED assessment and Dialysis Score for refining interfacility transfer decisions based on resource intensity.Clinical trial numberNot applicable.
dc.identifier.doi10.1186/s12873-025-01322-9
dc.identifier.issn1471-227X
dc.identifier.issue1
dc.identifier.pmid40830928
dc.identifier.scopus2-s2.0-105013570331
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org./10.1186/s12873-025-01322-9
dc.identifier.urihttps://hdl.handle.net/20.500.12662/10754
dc.identifier.volume25
dc.identifier.wosWOS:001554095400001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherBmc
dc.relation.ispartofBmc Emergency Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WoS_20260128
dc.subjectEarthquake
dc.subjectEmergency department
dc.subjectDialysis
dc.subjectRenal replacement therapy
dc.subjectDisaster
dc.subjectCrush syndrome
dc.subjectCrush injury
dc.titleExternal validation and comparison of SAFE QUAKE and dialysis score in earthquake related crush injuries
dc.typeArticle

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