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Pediatric neurosurgery during Operation Enduring Freedom
Paul Klimo1, Brian T Ragel, William H Scott
188th Medical Group, Wright-Patterson Air Force Base, Ohio 45433, USA. atomkpnk@yahoo.com
Insights
Pediatric neurosurgery in Afghanistan treated 43 children, performing 57 procedures for battlefield trauma and humanitarian needs. Military neurosurgeons provided critical care despite challenging conditions.
Area of Science:
- Military medicine
- Pediatric neurosurgery
- Global health
Background:
- Operation Enduring Freedom (OEF) in Afghanistan necessitated continuous neurosurgical support.
- Craig Joint Theater Hospital (CJTH) established pediatric neurosurgical services in 2007.
- CJTH treats children with war-related injuries and selective non-war-related conditions.
Observation:
- A review of 296 neurosurgical procedures from September 2007 to October 2009.
- Identified 57 procedures in 43 pediatric patients (11 days to 18 years).
- Average patient age was 7.5 years, with 16 girls and 27 boys.
Findings:
- 54% of procedures (31/57) were for battlefield trauma, 46% (26/57) for humanitarian reasons.
- Cranial procedures (49/57) predominated, with craniotomies/craniectomies for penetrating brain injuries being most common.
- In-hospital complications occurred in 11.6% (5/43) and mortality in 9.3% (4/43) of pediatric patients.
Implications:
- Children are significant victims of the Afghanistan conflict, requiring specialized neurosurgical care.
- Air Force neurosurgeons provide essential, life-saving pediatric treatment in austere environments.
- Continued military neurosurgical support is vital for injured children during ongoing conflict.
Object:
Operation Enduring Freedom (OEF) is the current US military conflict against terrorist elements in Afghanistan. Deepening US involvement in this conflict and increasing coalition casualties prompted the establishment of continuous neurosurgical assets at Craig Joint Theater Hospital (CJTH) at Bagram Airfield, Afghanistan, in September 2007. As part of the military's medical mission, children with battlefield-related injuries and, on a selective case-by-case basis, non-war-related pathological conditions are treated at CJTH.
Methods:
A prospectively maintained record was created in which all rotating neurosurgeons at CJTH recorded their personal procedures. From this record, the authors were able to extract all cases involving patients 18 years of age or younger. Variables recorded included: age, sex, and category of patient (for example, local national, enemy combatant), date, indication and description of the neurosurgical procedure, mechanism of injury, and in-hospital morbidity and mortality data.
Results:
From September 2007 to October 2009, 296 neurosurgical procedures were performed at CJTH. Fifty-seven (19%) were performed in 43 pediatric patients (16 girls and 27 boys) with an average age of 7.5 years (range 11 days-18 years). Thirty-one of the 57 procedures (54%) were for battlefield-related trauma and 26 for humanitarian reasons (46%). The vast majority of cases were cranial (49/57, 86%) compared with spinal (7/54, 13%), with one peripheral nerve case. Craniotomies or craniectomies for penetrating brain injuries were the most common procedures. There were 5 complications (11.6%) and 4 in-hospital deaths (9.3%).
Conclusions:
As in previous military conflicts, children are the unfortunate victims of the current Afghanistan campaign. Extremely limited pediatric neurosurgical service and care is rendered under challenging conditions and Air Force neurosurgeons provide valuable, life-saving pediatric treatment for both war-related injuries and humanitarian needs. As the conflict in Afghanistan continues, military neurosurgeons will continue to care for injured children to the best of their abilities.
