Golden Hours in Disaster Response and Early Clinical Outcomes: An Analysis of the First 24 Hours of the Kahramanmaraş Earthquake

Background: This study examined the association between admission time within 24 h of the Kahramanmaraş earthquakes and trauma severity, rhabdomyolysis, and in-hospital mortality, and its potential as a temporal reference for field triage in mass-casualty incidents. Methods: This retrospective study included earthquake-related injury patients who presented to our tertiary emergency department within 24 h of the earthquake onset (04:17, 6 February 2023). Non-survivors who died before diagnostic work-up, and therefore had no laboratory results or trauma scores, were excluded from the analysis. Patients were compared by admission within the golden hour (≤6 h) or later (>6 h); laboratory samples were obtained within the first hour of presentation. Mortality predictors were examined using univariate and multivariable logistic regression, and receiver operating characteristic (ROC) analysis evaluated admission time for predicting rhabdomyolysis. Results: Three of 63 patients (4.8%) died; lower Glasgow Coma Scale scores and higher trauma severity indices were associated with mortality, whereas admission time and entrapment were not (very few deaths). Patients admitted after 6 h had higher Abbreviated Injury Scale (AIS) grades and significantly higher creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and international normalized ratio (INR) values and longer hospitalizations. Admission time predicted rhabdomyolysis well (area under the curve [AUC] = 0.840; cutoff: 9 h) and correlated positively with log-transformed CK (r = 0.733). Conclusions: The initial temporal window may be associated with muscle and organ injury severity among patients reaching hospital, but does not support redefining the golden hour as a survival determinant across the care continuum. The time threshold is hypothesis-generating and requires external validation before field triage use.