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Published on: February 8, 2022
An Analysis of Intracranial Hemorrhage in Wartime Pediatric Casualties
Camaren M Cuenca1, Emily E Clarke2, Bradley A Dengler3
1U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA; University of Notre Dame, Notre Dame, Indiana, USA.
Insights
Pediatric intracranial hemorrhage (ICH) occurred in 14% of combat casualties. Most children survived, though less than half received decompression procedures, highlighting a need for further research in pediatric TBI.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Military Medicine
Background:
- Pediatric traumatic head injuries, including intracranial hemorrhage (ICH), are understudied in military settings.
- Research on adult combat head injuries is extensive, but pediatric data is lacking.
- Understanding pediatric ICH is crucial for combat support hospitals treating children.
Purpose of the Study:
- To describe the incidence and outcomes of intracranial hemorrhage (ICH) in pediatric combat casualties.
- To analyze the types of ICH and their associated treatments in children.
- To evaluate survival rates for pediatric patients with ICH.
Main Methods:
- Secondary analysis of the Department of Defense Trauma Registry (2007-2016).
- Inclusion of all pediatric casualties from conflicts in Iraq and Afghanistan.
- Focused search for cases involving intracranial hemorrhage (ICH).
Main Results:
- Intracranial hemorrhage (ICH) was identified in 495 (14%) of 3439 pediatric encounters.
- Common ICH types included subdural (47.9%) and not otherwise specified (48.3%).
- Most pediatric patients (79%) survived to hospital discharge; 4.4% received prehospital ketamine.
Conclusions:
- 495 cases of pediatric intracranial hemorrhage (ICH) were identified in combat casualties.
- The majority of pediatric patients with ICH survived, despite fewer than half undergoing decompression.
- Further investigation into pediatric TBI management and outcomes is warranted.
Background:
Children make up a significant cohort of patients treated at combat support hospitals. Where traumatic head injury, including intracranial hemorrhage (ICH), is well studied in military adults, such research is lacking regarding pediatric patients. We seek to describe the incidence and outcomes of ICH within this population.
Methods:
This is a secondary analysis of a previously published dataset from the Department of Defense Trauma Registry for all pediatric casualties in Iraq and Afghanistan from January 2007 to January 2016. Within our dataset, we searched for casualties with an ICH.
Results:
Of the 3439 pediatric encounters in our dataset, we identified 495 (14%) casualties that had at least 1 type of ICH. Most were between 5 and 12 years of age, male (74%), and injured by an explosive (42%). Of the casualties with ICHs, 82 had epidural (16.6%), 237 had subdural (47.9%), 153 had subarachnoid (30.9%), 157 had parenchymal bleeds (31.7%), and 239 had ICHs not otherwise specified (48.3%). In the hospital setting, the epidural group was more frequently treated with skull decompression (41%) and craniotomy with skull elevation (28%). The subdural group was more frequently treated with a craniectomy (17%) and the parenchymal group had more frequent intracranial pressure monitoring (18%). In our dataset, 22 received ketamine prehospital (4.4%) and most were discharged alive from the hospital (79%).
Conclusions:
Within our dataset, we identified 495 cases of ICH in pediatric patients. Most survived to hospital discharge despite less than half undergoing a decompression procedure.
