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Pediatric casualties in contemporary armed conflict: A systematic review to inform standardized reporting
Hannah Wild1, Barclay T Stewart2, Christopher LeBoa3
1Department of Surgery, University of Washington, Seattle, WA USA.
Insights
Children in modern conflicts sustain more blast injuries than adults, with slightly higher mortality. More uniform data is needed to fully understand pediatric conflict injuries and improve health responses.
Area of Science:
- Pediatric injury epidemiology
- Conflict medicine
- Public health in armed conflict
Background:
- Children are disproportionately affected by conflict casualties.
- Understanding pediatric conflict-related injuries is crucial for effective health responses.
- Current data on child injuries in 21st-century conflicts is limited.
Purpose of the Study:
- To analyze the epidemiology of conflict-related injuries in children.
- To inform local, military, and humanitarian health planning.
- To identify patterns and outcomes of pediatric injuries in modern warfare.
Main Methods:
- Systematic literature search across major scientific databases (PubMed, Embase, Web of Science, WHO Catalog, Google Scholar).
- Inclusion of records detailing conflict-related injuries in children since 2001.
- Analysis of 9 eligible reports representing 5,100 pediatric patients across 5 conflicts.
Main Results:
- Blast injury was the most frequent mechanism in children (57%), significantly higher than in adults (24.8%).
- Child mortality (11.0%) was slightly, but significantly, higher than adult mortality (9.8%).
- Data limitations due to non-uniform reporting prevented pooled analysis.
Conclusions:
- Children experience a higher relative burden of blast injuries in armed conflict.
- While child mortality is higher, the difference compared to adults is less pronounced than previously suggested.
- Inconsistent data reporting hinders a comprehensive understanding of pediatric needs in conflict zones.
Background:
Children represent a significant percentage of casualties in modern conflict. Yet, the epidemiology of conflict-related injury among children is poorly understood. A comprehensive analysis of injuries sustained by children in 21st-century armed conflict is necessary to inform planning of local, military, and humanitarian health responses.
Methods:
We conducted a systematic search of databases including PubMed, Embase, Web of Science, World Health Organization Catalog, and Google Scholar to identify records that described conflict-related injuries sustained by children since 2001.
Results:
The search returned 5,264 records. 9 eligible reports without potentially duplicative data were included in analysis, representing 5,100 pediatric patients injured in 5 conflicts. Blast injury was the most frequent mechanism (57%), compared to 24.8% in adults. Mortality was only slightly higher among children (11.0% compared to 9.8% among adults; p <0.05). Non-uniform reporting prevented pooled analysis and limited the conclusions that could be drawn.
Conclusions:
Children sustain a higher proportion of blast injury than adults in conflict. Existing data do support the conclusion that child casualties have higher mortality than adults overall; however, this difference is slighter than has been previously reported. Specific subpopulations of children appear to have worse outcomes. Overall, non-uniform reporting renders currently available data insufficient to understand the needs of children injured in modern conflict.
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