Related Experiment Video
Updated: Apr 15, 2026
Author Spotlight: Developing Precise and Clinically Relevant Models for Studying Secondary Degeneration in Traumatic Optic Neuropathy
Published on: November 29, 2024
Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts
Paul Klimo1, Brian T Ragel, G Morgan Jones
1*Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee; ‡Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee; §Department of Neurosurgery, Mercy Hospital and Clinic, Springfield, Missouri; ¶Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee; ‖Wilford Hall Medical Center, Lackland Air Force Base, Texas.
Insights
This study analyzed severe head injuries in children during Operations Enduring Freedom and Iraqi Freedom. Higher Glasgow Coma Scores and male sex predicted survival in pediatric combat casualties.
Area of Science:
- Pediatric Traumatology
- Military Medicine
- Neurotrauma Epidemiology
Background:
- Civilian child injuries in conflict zones are under-documented.
- Focus on combat-related pediatric head trauma is limited.
Purpose of the Study:
- To characterize the epidemiology and outcomes of isolated severe head injuries in children during OEF and OIF.
- To identify factors influencing survival in pediatric combat casualties.
Main Methods:
- Retrospective review of the Joint Theater Trauma Registry (2004-2012).
- Included children (<18 years) with isolated severe head injury (AIS >3).
- Analyzed data from US combat support hospitals in Iraq and Afghanistan.
Main Results:
- 647 children with severe isolated head injuries identified.
- Penetrating injuries were most common (60.6%).
- In-hospital mortality was 24.1%; Glasgow Coma Score and male sex predicted survival.
Conclusions:
- This is the largest study on combat-related pediatric head injuries.
- Glasgow Coma Score and male sex are key predictors of survival.
- Need for early establishment of pediatric care assets in future conflicts.
Background:
Much has been written about injuries sustained by US and coalition soldiers during the Global War on Terrorism campaigns. However, injuries to civilians, including children, have been less well documented.
Objective:
To describe the epidemiologic features and outcomes associated with isolated severe head injury in children during Operations Enduring Freedom and Iraqi Freedom (OEF and OIF).
Methods:
A retrospective review of children (<18 years old) in the Joint Theater Trauma Registry with isolated head injury (defined as an Abbreviated Injury Score Severity Code >3) and treated at a US combat support hospital in Iraq or Afghanistan (2004-2012). The primary outcome was in-hospital mortality.
Results:
We identified 647 children with severe isolated head injuries: 337 from OEF, 268 from OIF, and 42 nontheater specific. Most were boys (76%; median age = 8 years). Penetrating injuries were most common (60.6%). Overall, 330 (51%) children underwent a craniotomy/craniectomy; 156 (24.1%) succumbed to their injuries. Admission Glasgow Coma Score was predictive of survival among the entire cohort and each of the individual conflicts. Male sex also significantly increased the odds of survival for the entire group and OEF, but not for OIF. Closed-head injury improved the predictive ability of our model but did not reach statistical significance as an independent factor.
Conclusion:
This is the largest study of combat-related isolated head injuries in children. Admission Glasgow Coma Score and male sex were found to be predictive of survival. Assets to comprehensively care for the pediatric patient should be established early in future conflicts.
