Predictive model for estimating risk of crush syndrome: a data mining approach.
BACKGROUND
There is no standard triage method for earthquake victims with crush injuries because of a scarcity of epidemiologic and quantitative data. We conducted a retrospective cohort study to develop predictive models based on clinical data for crush injury in the Kobe earthquake.


METHODS
The medical records of 372 patients with crush injuries from the Kobe earthquake were retrospectively analyzed. Twenty-one risk factors were assessed with logistic regression analysis for three outcomes relating to crush syndrome. Two types of predictive triage models--initial evaluation in the field and secondary assessment at the hospital--were developed using logistic regression analysis. Classification accuracy, Brier score and area under the receiver operating characteristic curve (AUC) were used to evaluate the model.


RESULTS
The initial triage model, which includes pulse rate, delayed rescue, and abnormal urine color, has an AUC of 0.73. The secondary model, which includes WBC, tachycardia, abnormal urine color, and hyperkalemia, shows an AUC of 0.76.


CONCLUSIONS
These triage models may be especially useful to nondisaster experts for distinguishing earthquake victims at high risk of severe crush syndrome from those at lower risk. Application of the model may allow relief workers to better utilize limited medical and transportation resources in the aftermath of a disaster.
Aoki
Noriaki
N
School of Health Information Sciences, University of Texas Health Science Center, Houston, Texas 77030, USA. noriaki.aoki@uth.tmc.edu
Demsar
Janez
J
Zupan
Blaz
B
Mozina
Martin
M
Pretto
Ernesto A
EA
Oda
Jun
J
Tanaka
Hiroshi
H
Sugimoto
Katsuhiko
K
Yoshioka
Toshiharu
T
Fukui
Tsuguya
T
D000704:Analysis of Variance; D015331:Cohort Studies; D003444:Crush Syndrome / Q000175:diagnosis*; D004190:Disasters; D005260:Female; D006801:Humans; D006947:Hyperkalemia; D007564:Japan; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011674:Pulse; D018635:Rescue Work / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013610:Tachycardia; D014218:Triage / Q000379:methods*; D014556:Urine