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Pediatric Thoracic Trauma in Iraq and Afghanistan
Ryan J Keneally1, Cynthia H Shields1, Albert Hsu1
1Department of Anesthesiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
Insights
Pediatric thoracic trauma in military settings is often penetrating, with higher mortality in younger children. Hemothorax, head injury, and burns significantly increase mortality risk in these young patients.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Military Medicine
Background:
- Pediatric thoracic trauma is a significant concern in conflict zones.
- Understanding injury patterns and outcomes is crucial for improving care.
- Data from U.S. military treatment facilities in Iraq and Afghanistan provide unique insights.
Purpose of the Study:
- To review data on pediatric thoracic trauma in U.S. military facilities in Iraq and Afghanistan.
- To describe injury scope, patterns, and mortality.
- To compare findings with adult trauma and existing literature.
Main Methods:
- Retrospective review of the Joint Theatre Trauma Registry.
- Inclusion of patients under 18 with thoracic trauma (ICD-9 codes).
- Statistical analysis including t-test, Mann-Whitney, chi-squared, ANOVA, and logistic regression.
Main Results:
- 955 pediatric patients (12% of thoracic trauma cases).
- Penetrating injuries (73.6%) were common; diagnoses included contusions, pneumothorax, and fractures.
- Overall pediatric mortality was 15.2%; mortality inversely related to age, highest in children under 2 (25.1%).
- Thoracic vascular/cardiac injuries, hemothorax, and head injuries increased mortality risk.
- Burns had high incidence (2.7%) and mortality (46.2%).
- Nearly half (47%) required transfusion.
Conclusions:
- Penetrating injuries predominated, often requiring transfusions.
- Mortality in pediatric thoracic trauma is inversely related to age.
- Hemothorax, head injury, and burns are associated with significantly increased mortality.
Introduction:
The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature.
Materials And Methods:
The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student's t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated.
Results:
There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%).
Conclusion:
Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality.
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