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A Novel In Vitro Model of Blast Traumatic Brain Injury
Published on: December 21, 2018
The pattern of paediatric blast injury in Afghanistan
Daniel C Thompson1,2, R J Crooks3, J C Clasper4,5
1Defence Medical Group South, Queen Alexandra Hospital, Portsmouth, UK dcthompson101@gmail.com.
Insights
Children injured by explosive remnants of war and improvised explosive devices (IEDs) are at higher risk for severe head injuries. This study reviewed paediatric blast injuries, finding children are disproportionately affected by head trauma.
Area of Science:
- Trauma Surgery
- Paediatric Injury Epidemiology
- Military Medicine
Background:
- Armed conflict in Afghanistan resulted in significant child casualties from 2009-2015.
- Improvised explosive devices (IEDs) and explosive remnants of war (ERW) comprised 29% of child injuries in 2015.
- Paediatric blast injuries represent a critical public health concern in conflict zones.
Purpose of the Study:
- To assess the burden of paediatric blast injuries treated at Camp Bastion, Afghanistan.
- To investigate if children sustain proportionally more head injuries than adults from blast events.
- To analyze injury patterns and severity in paediatric blast trauma.
Main Methods:
- Retrospective analysis of prospectively collected data from the UK Joint Theatre Trauma Registry.
- Inclusion of ambulant paediatric patients (aged 2-15 years) admitted with blast injuries from June 2006 to March 2013.
- Examination of demographic data, injury profiles (New Injury Severity Score), and operative findings.
Main Results:
- 295 paediatric admissions were identified, with a 18.5% mortality rate.
- Improvised explosive devices (IEDs) were the primary cause, accounting for 68% of blast mechanisms and 80% of fatalities.
- Lower extremities were most frequently injured (31%), but severe head/neck injuries were more prevalent in younger children (2-7 years) and unsurvivable head injuries accounted for 88% of deaths.
Conclusions:
- Paediatric blast casualties, though a small fraction of the workload, exhibit distinct injury patterns.
- Children are more susceptible to severe head, face, and neck injuries compared to adults.
- Findings highlight the vulnerability of children to devastating blast-related trauma, particularly to the head.
Introduction:
Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults.
Method:
A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2-15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region.
Results:
During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%).
Conclusion:
Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults.
