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Blast injury in children: an analysis from Afghanistan and Iraq, 2002-2010
Mary J Edwards1, Michael Lustik, Martin R Eichelberger
1Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA.
Insights
Children injured by blast explosions experience unique patterns and require intensive, specialized care. Their injuries, particularly head/neck trauma and burns, predict mortality, highlighting significant treatment needs.
Area of Science:
- Pediatric Trauma Surgery
- Blast Injury Epidemiology
- Military Medicine
Background:
- Children are vulnerable victims of armed conflict, yet blast injury patterns, physiological effects, and treatment needs are poorly understood.
- Blast injuries in pediatric populations remain underdocumented, necessitating further research into their unique characteristics.
Purpose of the Study:
- To analyze the demographic, injury, and outcome patterns of pediatric civilians sustaining blast injuries.
- To identify specific injury types and physiological markers predictive of mortality in children affected by explosive devices.
Main Methods:
- Retrospective analysis of civilian blast injury data from the Joint Theatre Trauma Registry (2002-2010).
- Stratification by age to compare anatomic injury patterns, Injury Severity Score (ISS), Revised Trauma Score (RTS), mortality, and resource utilization.
- Multivariate logistic regression to identify independent predictors of mortality.
Main Results:
- Children under 15 comprised 25% of civilian blast injuries, with those aged 8-14 experiencing higher ISS and longer hospital stays.
- Pediatric injuries were more concentrated in the head and neck, with lower RTS compared to adults.
- Mortality strongly correlated with burns, head injury, and transfusion; however, adolescents had lower mortality rates.
Conclusions:
- Pediatric blast injuries present a distinct anatomic pattern and severe physiological derangement (lower RTS).
- Head/neck injuries, burns, and need for transfusion are significant predictors of mortality across all age groups.
- The 7% mortality rate underscores the severity and resource-intensive nature of pediatric blast injury care, requiring multidisciplinary surgical expertise.
Background:
Throughout history, children have been victims of armed conflict, including the blast injury complex, however, the pattern of injury, physiologic impact, and treatment needs of children with this injury are not well documented.
Methods:
The Joint Theatre Trauma Registry provides data on all civilians admitted to US military treatment facilities from 2002 to 2010 with injuries from an explosive device. The data were stratified by age and analyzed for differences in anatomic injury patterns, Injury Severity Score (ISS), Revised Trauma Score (RTS), mortality, intensive care unit days, and length of hospitalization. Multivariate logistic regression was done to determine independent predictors of mortality. All operative procedures with a specified site were tabulated and categorized by body region and age.
Results:
A total of 4,983 civilian patients were admitted, 25% of whom were younger than 15 years. Pediatric patients aged 8 to 14 years had a higher ISS and hospital stay than other age groups, and children younger than 15 years had a longer intensive care unit stay. Injuries in children were more likely to occur in the head and neck and less likely in the bony pelvis and extremities. Children had a lower RTS than the other age groups. Mortality correlated highly with burns, head injury, transfusion, and RTS. Adolescent patients had a lower mortality rate than the other age groups. Improvised explosive devices were the most common cause of injury in all age groups.
Conclusion:
Children experiencing blast injury complex have an anatomic pattern that is unique and an RTS that reflects more severe physiologic derangement. Injuries requiring transfusion or involving the head and neck and burns were predictive of mortality, and this persisted across all age groups. The mortality rate of children with blast injury is significant (7%), and treatment is resource intensive, requiring many surgical subspecialties.
Level Of Evidence:
Epidemiologic study, level III.
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