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Prehospital Interventions Performed on Pediatric Trauma Patients in Iraq and Afghanistan
Insights
Military medical units frequently treat pediatric trauma patients in combat zones. Vascular access and hypothermia prevention were the most common interventions for these young casualties.
Area of Science:
- Military Medicine
- Pediatric Trauma Care
- Emergency Medicine
Background:
- Military medical units in combat zones encounter numerous pediatric trauma patients.
- Pediatric patients present unique challenges due to their physiology, and military providers often lack specialized training.
- Limited data exists on the prehospital care of pediatric patients in combat environments.
Purpose of the Study:
- To describe the prehospital care provided to pediatric trauma patients in Iraq and Afghanistan.
- To analyze interventions related to trauma resuscitation in pediatric casualties.
Main Methods:
- Data was extracted from the Department of Defense Trauma Registry (DODTR) for pediatric subjects (age <18) admitted to fixed-facility hospitals in Iraq and Afghanistan between January 2007 and January 2016.
- Subjects were categorized into age groups: <1, 1-4, 5-9, 10-14, and 15-17 years.
- Analysis focused on trauma resuscitation interventions and medications administered.
Main Results:
- Out of 42,790 total encounters, 3,439 (8.0%) were pediatric (<18 years).
- The majority of pediatric subjects were in the 5-9 age group (33.1%), male (77.1%), located in Afghanistan (67.8%), and injured by explosives (43.1%).
- Most pediatric patients survived to hospital discharge (90.2%). Frequently performed interventions included vascular access (IV/IO: 29.9%) and hypothermia prevention (44.5%). Opioids (15.0%) and antibiotics (6.2%) were most common medications.
Conclusions:
- Pediatric casualties represented over 1 in 13 treated in joint theaters, with explosive injuries being the most common cause.
- Vascular access and hypothermia prevention were the most frequent interventions for pediatric trauma patients in these combat zones.
Background:
United States (US) and coalition military medical units deployed to combat zones frequently encounter pediatric trauma patients. Pediatric patients may present unique challenges due to their anatomical and physiological characteristics and most military prehospital providers lack pediatric-specific training. A minimal amount of data exists to illuminate the prehospital care of pediatric patients in this environment. We describe the prehospital care of pediatric trauma patients in Iraq and Afghanistan.
Methods:
We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. Subjects were grouped by age: <1, 1-4, 5-9, 10-14, and 15-17 years. We focused our analysis on interventions related to trauma resuscitation.
Results:
Of 42,790 encounters in the DODTR during the study period, 3,439 (8.0%) were aged <18 years. Most subjects were in the 5-9 age group (33.1%), male (77.1%), located in Afghanistan (67.8%), injured by explosives (43.1%). Most subjects survived to hospital discharge (90.2%). The most frequently performed interventions were tourniquet placement (6.6%), intubation (6.1%), supplemental oxygen (11.7%), IV access (24.8%), IV fluids (13.3%), IO access (5.1%), and hypothermia prevention (44.5%). The most frequently administered medications were antibiotics (6.2%) and opioids (15.0%). Most procedural and medication interventions occurred in subjects injured by explosives (43.1%) and gunshot wounds (22.1%).
Conclusions:
Pediatric subjects comprised over 1 in 13 casualties treated in the joint theaters with the majority injured by explosives. Vascular access and hypothermia prevention interventions were the most frequently performed procedures.
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