Combat-Related Genitourinary Trauma in Pediatric Patients: Data From the Department of Defense Trauma Registry

Deploying surgeons frequently train, prepare, and bring equipment to manage adult trauma patients without sufficient planning and consideration for pediatric trauma populations. Pediatric urotrauma in this setting requires specialty care as part of the humanitarian mission. We determine the incidence of genitourinary trauma and relevant surgical procedures within the pediatric population seen in US military treatment facilities in Afghanistan and Iraq from January 2007 to January 2016.

We analyzed the prospectively maintained Department of Defense Trauma Registry between 2007 and 2016. We used diagnostic and procedural codes to identify any pediatric casualties who arrived at a military treatment facility with urological-based injuries. We compared the characteristics of pediatric patients with urologic injuries versus pediatric patients with non-urological injuries.

The registry contained 42,790 casualties, of which 3439 (8.0 %) were pediatric by documented or estimated age. Within that, 430 (13 %) had at least one urological diagnostic or procedural code. Ages and the proportion of males to females were similar across the two groups. Explosive (48 %) and firearm (24 %) injuries were the predominant mechanisms of injury. The median injury severity score was 16 (IQR 9-22). The urological injury group was more likely to have serious injuries to the abdomen and extremities (27 %). Pelvic fractures were seen in 11 % of injuries with urotrauma. Most patients survived to hospital discharge (92 %). Massive transfusion protocols were activated in 31 % of patients with urologic wounds compared to 14 % without urologic injury. The most common procedures were surgical interventions to the bladder (70 %). Renal injuries comprised 20 % of all urological injuries; 41 % required operative intervention, with 60 % being nephrectomies.

In combat situations, pediatric urotrauma is observed to be more frequent and often presents with more severe injuries compared to adults. Our findings highlight the need for pediatric genitourinary-specific training for deploying surgeons.