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

Background: This 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 Türkiye earthquakes.

Methods: In 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.

Results: The 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).

Conclusion: Following catastrophic disasters such as the February 6 Türkiye 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 number: Not applicable.