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Surgical interventions for pediatric blast injury: an analysis from Afghanistan and Iraq 2002 to 2010
Mary J Edwards1, Michael Lustik, Terri Carlson
1From the Departments of Surgery (M.J.E., T.C., B.T., D.F., K.E., M.E.) and Clinical Investigation (M.L.), Tripler Army Medical Center, Honolulu, Hawaii.
Insights
Pediatric blast injuries necessitate substantial operative interventions. Children aged 9-14 required more procedures than adults, highlighting the need for specialized pediatric surgical resources after explosions.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Military Medicine
Background:
- Acute blast injury management demands aggressive surgical intervention.
- This study analyzes operative procedures for pediatric blast injuries in US military facilities (2002-2010).
Purpose of the Study:
- To document therapeutic procedures for children with blast injuries.
- To understand the pediatric operative resources required following explosions.
Main Methods:
- Utilized the Joint Theatre Trauma Registry for data on pediatric blast injury patients.
- Stratified data by age groups (0-3, 4-8, 9-14, 15-19, >19 years).
- Analyzed procedures by age, body region, and Abbreviated Injury Scale (AIS) score.
Main Results:
- 25% of 5,026 blast-injured patients were children (≤14 years), requiring an average of 4.5 procedures.
- Children aged 9-14 underwent more procedures (5/patient) than adults (4.5/patient); younger children (≤3 years) underwent fewer (3.15/patient).
- Severe injuries (AIS ≥ 3) increased invasive procedures (30-90%); children were more likely to need procedures for head and thoracic injuries.
Conclusions:
- Blast-injured children require significant operative resources during the acute injury phase.
- Specialized pediatric operative resources and expertise are crucial in response to explosive attacks.
Background:
Acute blast injury requires aggressive operative intervention. This study documents therapeutic procedures required for children with blast injury in Afghanistan and Iraq from 2002 to 2010 at US military treatment facilities, to understand pediatric operative resources required after explosions.
Methods:
The Joint Theatre Trauma Registry provides data for the previously mentioned population. The data were stratified by years of age as follows: 0 to 3, 4 to 8, 9 to 14, 15 to 19, older than 19 years. Therapeutic procedures were defined by DRG International Classification of Diseases-9th Rev. codes 0 to 86.99. These were analyzed by age, body region, and Abbreviated Injury Scale (AIS) score.
Results:
A total of 5,026 patients with a known age requiring a total of 22,677 therapeutic procedures were analyzed; 25% (n = 1,205) were children 14 years or younger. On average, 4.5 procedures were required per patient and varied significantly by age. Soft tissue debridement, vascular access procedure, laparotomy, and thoracostomy were the most common procedures for all ages. For all body regions, severe injury (AIS score ≥ 3) was associated with an increased need for an invasive procedure (30-90%) in that region. Children 9 years to 14 years of age underwent significantly more procedures on average (5 procedures per patient) compared with adults (4.5 procedures per patient); children 3 years and younger underwent significantly less (3.15 procedures per patient). Children 4 years to 14 years of age were more likely than older patients to undergo a procedure for a severe head injury (40% vs. 29%), and those 9 years to 14 years old were more likely to undergo a procedure for severe thoracic injury (72%). After 4 years of age, procedures trend away from the head toward the extremity and amputation.
Conclusion:
Blast-injured children require significant operative resources during the acute phase of injury. In the event of an explosive attack, pediatric operative resources and expertise are required.
Level Of Evidence:
Epidemiologic study, level III.
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