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Wartime paediatric extremity injuries: experience from the Kabul International Airport Combat support hospital
Laurent Mathieu1, Antoine Bertani, Frédéric Rongiéras
1aDepartment of Orthopaedic and Trauma Surgery, Desgenettes Military Teaching Hospital, Lyon bDepartment of Paediatric Orthopaedic and Trauma Surgery, Armand Trousseau Hospital, Paris cDepartment of Orthopaedic and Trauma Surgery, Bégin Military Teaching Hospital, Saint-Mandé, France.
Insights
Pediatric wartime extremity injuries, both combat and non-combat related, were analyzed. Most injuries were treatable in combat support hospitals by trained surgeons, with a low mortality rate.
Area of Science:
- Orthopedic Surgery
- Military Medicine
- Pediatric Trauma
Background:
- Management of pediatric casualties, including children, is a priority in battlefield medical support during Operation Enduring Freedom.
- Understanding the characteristics and treatment of pediatric wartime extremity injuries is crucial for optimizing care in deployed settings.
Purpose of the Study:
- To describe the features of pediatric wartime extremity injuries.
- To analyze the management of these injuries in a Level 3 medical facility (Kabul International Airport Combat Support Hospital).
Main Methods:
- Retrospective review of the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013.
- Inclusion criteria: pediatric patients (<16 years old) with extremity injuries.
- Analysis of combat-related injuries (CRIs) versus non-combat-related injuries (NCRIs).
Main Results:
- 155 pediatric patients (mean age 9.1 years) with extremity injuries were included.
- 77 sustained CRIs (predominantly open injuries) and 78 NCRIs (predominantly blunt injuries).
- CRIs were associated with more multiple extremity and severe injuries (higher Injury Severity Score). Debridement/irrigation common for CRIs; internal fixation for NCRIs.
- Global mortality rate was 2.6% (4 deaths).
Conclusions:
- This study provides the first specific analysis of pediatric extremity trauma in recent conflicts at a Level 3 facility.
- Except for severe burns and polytrauma, pediatric extremity injuries are manageable in Combat Support Hospitals by experienced orthopedic surgeons.
- Effective treatment protocols for pediatric wartime extremity trauma can be implemented in deployed military hospitals.
Abstract:
Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. Paediatric patients were defined as those younger than 16 years old. Of the 220 injured children operated on, 155 (70%) sustained an extremity injury and were included. The mean age of the children was 9.1 ± 3.8 years. Among these children, 77 sustained combat-related injuries (CRIs) and 78 sustained noncombat-related injuries (NCRIs), with a total of 212 extremities injuries analysed. All CRIs were open injuries, whereas NCRIs were dominated by blunt injuries. Multiple extremities injuries and associated injuries were significantly more frequent in children with CRIs, whose median Injury Severity Score was higher than those with NCRIs. Debridement and irrigation was significantly predominant in the CRIs group, as well as internal fracture fixation in the NCRIs group. There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma.
