Pediatric Wartime Injuries in Afghanistan and Iraq: What Have We Learned?

Area of Science:

• Military medicine
• Pediatric trauma surgery
• Combat casualty care

Background:

• Inpatient Role 3 missions represent the primary source of pediatric trauma care data from the past decade of conflict.
• Pediatric patients (≤14 years) comprised 5%–10% of combat admissions.
• Care for these pediatric casualties was resource-intensive, with higher mortality rates compared to civilian pediatric hospitals.

Purpose of the Study:

• To analyze the characteristics and outcomes of pediatric trauma care in a conflict setting.
• To highlight the significant experience gained in managing explosive injuries and massive transfusions in children.
• To identify the need for long-term outcome data and clinical practice guidelines for pediatric combat casualties.

Main Methods:

• Retrospective review of documented experience from inpatient Role 3 missions over a decade of conflict.
• Analysis of pediatric patient demographics, injury types, resource utilization, and mortality rates.
• Comparison of outcomes with established pediatric hospital data from the United States.

Main Results:

• Pediatric patients represented a significant minority (5%–10%) of combat admissions.
• The conflict provided the largest documented experience with pediatric explosive injuries and massive transfusions.
• Mortality rates for pediatric combat casualties were substantially higher than in non-conflict settings.

Conclusions:

• Pediatric trauma care in conflict zones presents unique challenges, demanding significant resources and resulting in elevated mortality.
• While experience with severe injuries like explosive trauma and massive transfusions has grown, comprehensive long-term outcome data is lacking.
• Development of evidence-based clinical practice guidelines is crucial for optimizing future care of children injured in conflict.