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Evaluating Primary Blast Effects In Vitro
Published on: September 18, 2017
Pediatric Blast Trauma: A Systematic Review and Meta-Analysis of Factors Associated with Mortality and Description of
Matthew A Tovar1, Rebecca A Pilkington2, Tress Goodwin1,3
1School of Medicine and Health Sciences, George Washington University, Washington, DC USA.
Insights
Terrorism-related explosions significantly increase pediatric mortality and alter injury patterns. Understanding these differences is crucial for medical preparedness and response to pediatric blast injuries.
Area of Science:
- Pediatric Trauma and Blast Injury
- Public Health and Emergency Medicine
- Disaster Medicine
Background:
- Blast polytrauma presents a severe challenge in medical care.
- Limited data exists on pediatric blast injury risk factors and profiles.
- Specific guidelines for pediatric blast injury management are lacking.
Purpose of the Study:
- To identify risk factors for mortality in pediatric blast injuries.
- To compare injury profiles between terrorism-related and non-terrorism-related explosions in children.
- To inform disaster medical education for pediatric providers.
Main Methods:
- A PRISMA systematic review and meta-analysis of articles from 2000-2021.
- Data extraction on mortality and injury profiles from included studies.
- Bivariate unadjusted odds ratio (OR) analysis to determine risk factors and injury patterns.
Main Results:
- Terrorism-related explosions significantly increased mortality (OR = 32.73).
- High-grade explosives (Global War on Terror) were associated with increased mortality (OR = 1.28).
- Resuscitation in NATO-affiliated hospitals, fireworks, and US-based incidents decreased mortality.
- Terrorism blasts in children showed higher thoracoabdominal trauma (30.2%) and lower extremity trauma (31.8%) compared to non-terrorism blasts.
Conclusions:
- Terrorism-related explosions are linked to higher pediatric mortality and distinct injury profiles.
- Findings highlight the need for specialized training in managing pediatric blast injuries.
- Optimizing disaster medical education is essential for effective response to terror-related and other blast events.
Introduction:
Blast polytrauma is among the most serious mechanisms of injury confronted by medical providers. There are currently no specific studies or guidelines that define risk factors for mortality in the context of pediatric blast injuries or describe pediatric blast injury profiles.
Objective:
The objectives of this study were to evaluate risk factors for pediatric mortality and to describe differences in injury profiles between explosions related to terrorism versus unrelated to terrorism within the pediatric population.
Methods:
A PRISMA systematic review and meta-analysis was performed where articles published from the years 2000-2021 were extracted from PubMed. Mortality and injury profile data were extracted from articles that met inclusion criteria. A bivariant unadjusted odds ratio (OR) analysis was performed to establish protective and harmful factors associated with mortality and to describe the injury profiles of blasts related to terrorism. Statistical significance was established at P < .05.
Results:
Thirty-eight articles were included and described a total of 222,638 unique injuries. Factors associated with increased mortality included if the explosion was related to terrorism (OR = 32.73; 95% CI, 28.80-37.21; P < .05) and if the explosion involved high-grade explosives utilized in the Global War on Terror ([GWOT] OR = 1.28; 95% CI, 1.04-1.44; P < .05). Factors associated with decreased mortality included if the patient was resuscitated in a North Atlantic Treaty Organization (NATO)-affiliated combat trauma hospital (OR = 0.48; 95% CI, 0.37-0.62; P < .05); if the explosive was fireworks (OR = 3.20×10-5; 95% CI, 2.00×10-6-5.16×10-4; P < .05); and if the explosion occurred in the United States (OR = 2.40×10-5; 95% CI, 1.51×10-6-3.87×10-4; P < .05). On average, victims of explosions related to terrorism were 10.30 years old (SD = 2.73) with 68.96% (SD = 17.58%) of victims reported as male. Comparison of victims of explosions related to terrorism revealed a higher incidence of thoracoabdominal trauma (30.2% versus 8.6%), similar incidence of craniocerebral trauma (39.5% versus 43.1%), and lower incidence of extremity trauma (31.8% versus 48.3%) compared to victims of explosions unrelated to terrorism.
Conclusion:
Explosions related to terrorism are associated with increased mortality and unique injury profiles compared to explosions unrelated to terrorism in the pediatric population. Such findings are important for optimizing disaster medical education of pediatric providers in preparation for and management of acute sequelae of blast injuries-terror-related and otherwise.
