Abstract
<title>Abstract</title> <p>Purpose Earthquakes reshape how populations use emergency services — and their effects reach well beyond those directly injured. The broader impact on ED utilization among the general population remains poorly characterized. To compare ED visit characteristics, patient demographics, triage patterns, clinical outcomes, and per-patient visit frequency before and after the February 6, 2023 Kahramanmaraş earthquake, specifically excluding direct earthquake victims. Methods This retrospective cohort study analyzed 26,869 ED visits from 23,302 unique patients at a single tertiary regional referral center. Two equal 14-day periods were compared: pre-earthquake (January 23 – February 5, 2023; n = 14,744 visits) and post-earthquake (February 6–19, 2023; n = 12,125 visits), after excluding 686 directly injured patients identified by prospective ICD-10 coding per institutional disaster medicine protocol. Variables included demographics, triage category, admission area, specialty consultations, forensic classification, primary discharge diagnosis (first-listed ICD-10 code), and per-patient visit count. Statistical analyses used the Mann-Whitney U test and chi-square test (α = 0.05); effect sizes were reported as Cohen's d, rank-biserial r, Cramér's V, and odds ratios with 95% confidence intervals. Results Post-earthquake ED volume decreased 17.8%. Median age rose from 35 to 36 years (p = 0.026; d = 0.029). Surgical admissions increased from 17.2% to 19.6% (p < 0.001; V = 0.032). Triage shifted toward higher acuity (p = 0.040; V = 0.011). Overall consultation rates rose from 4.7% to 5.5% (p = 0.002; OR = 1.188, 95%CI: 1.065–1.325), with cardiology showing the largest and only clinically meaningful increase (0.67% to 1.07%; OR = 1.603, 95%CI: 1.233–2.085; p = 0.001). Per-patient visit frequency decreased significantly (mean 1.20 ± 0.62 vs 1.10 ± 0.36; d = 0.182; p < 0.001), with high-frequency users (≥ 4 visits) declining 84.1%. Conclusions Major earthquakes alter ED utilization in ways that extend well beyond direct victims. The post-earthquake period showed reduced overall volume alongside increased surgical and cardiovascular demand, higher triage acuity, and a marked drop in repeat visits. These patterns inform disaster preparedness planning and post-disaster resource allocation.</p>