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Updated: Apr 19, 2026
Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
Isolated pediatric burn injury in Iraq and Afghanistan
Matthew A Borgman1, Renée I Matos, Philip C Spinella
11Department of Pediatrics, San Antonio Military Medical Center, Fort Sam Houston, TX. 2Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Insights
Pediatric burn injuries in combat zones are severe, with mortality increasing significantly with burn severity. International normalized ratio and external Abbreviated Injury Scale score independently predicted mortality in children.
Area of Science:
- Trauma surgery
- Pediatric critical care
- Epidemiology
Background:
- Pediatric burn injuries present unique challenges in combat zones.
- Limited data exists on the epidemiology and outcomes of pediatric burn patients in military settings.
Purpose of the Study:
- To characterize the epidemiology of pediatric burn injuries in combat support hospitals.
- To identify factors associated with mortality in pediatric burn patients.
Main Methods:
- Retrospective cohort study of Iraqi and Afghan children (<18 years) admitted with isolated burn injury.
- Data collected from U.S. military combat support and forward surgical hospitals.
- Burn severity classified using external Abbreviated Injury Scale (AIS); multivariate logistic regression performed.
Main Results:
- Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury; overall mortality was 13%.
- Mortality increased with burn severity: mild (1.7%), moderate (7.2%), and severe (47%).
- Independent predictors of mortality included international normalized ratio (INR) and external AIS score.
Conclusions:
- Severe pediatric burns in combat zones are associated with high mortality and significant resource utilization.
- The findings highlight the need for specialized care for severely burned children in austere environments.
- Extraordinary measures are employed for the long-term care of these children within war zones.
Objectives:
To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity.
Design:
Retrospective cohort study.
Setting:
U.S. military combat support hospitals and forward surgical hospitals in Iraq and Afghanistan.
Patients:
Iraqi and Afghan children less than 18 years old admitted with isolated burn injury.
Interventions:
None.
Measurements And Main Results:
Burn severity was classified as mild, moderate, and severe based on external Abbreviated Injury Scale score. Patient characteristics and outcomes were described according to burn severity. A multivariate logistic regression was performed on univariate associations with mortality. Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury. Overall mortality was 13%, median external Abbreviated Injury Scale was 3 (interquartile range, 2-4), and 67% were male. Variables included in the logistic regression were external Abbreviated Injury Scale score, abnormal heart rate for age, hypotension, mechanical ventilation, transfusion, Glasgow Coma Scale, international normalized ratio, base deficit, hematocrit, and platelet count. Factors independently associated with mortality were international normalized ratio (odds ratio, 2.6; 95% CI, 1.2-5.8; p = 0.021) and external Abbreviated Injury Scale (odds ratio, 2.5; 95% CI, 1.3-4.7; p = 0.004). Mortality increased with burn severity: mild 1.7%, moderate 7.2%, and severe 47% (p < 0.001).
Conclusions:
This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.
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