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Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022

Sara E Bibbens1, Jonathan D Stallings2, Monica L Casmaer3

  • 1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Pediatrics
|March 9, 2026
PubMed

Insights

Pediatric mortality in conflict zones is high, with younger children and burn injuries linked to increased deaths. Greater blood loss and inadequate transfusion support in non-survivors highlight the need for improved hemorrhage control and pediatric-specific trauma protocols.

Area of Science:

  • Pediatric trauma research
  • Conflict medicine
  • Epidemiology of injuries

Background:

  • Pediatric mortality from conflict injuries is a significant concern, necessitating a deeper understanding of injury patterns and outcomes.
  • Effective resource allocation and training for pediatric care in conflict zones depend on robust data.

Purpose of the Study:

  • To characterize pediatric injuries in conflict zones.
  • To examine the relationship between injury patterns, resource availability, and survival rates in pediatric conflict casualties.
  • To identify factors contributing to pediatric mortality in austere, conflict-related settings.

Main Methods:

  • Retrospective cohort analysis of the Department of Defense Trauma Registry (2001-2022).
  • Inclusion criteria: children (<18 years) treated at military treatment facilities in conflict zones with documented injuries and discharge status.
  • Primary outcome: survival to hospital discharge.

Main Results:

  • A total of 5695 children were analyzed, with an overall mortality rate of 9.4%.
  • Nonsurvivors were younger, had higher injury severity scores, and sustained more burn injuries compared to survivors.
  • Nonsurvivors experienced significantly greater blood loss and required more transfusions, with suboptimal packed red blood cell-to-platelet ratios in both groups.

Conclusions:

  • This study reveals age-specific injury patterns and resuscitation requirements contributing to pediatric mortality in conflict zones.
  • Increased blood loss and resuscitation volumes in nonsurvivors emphasize the critical need for early hemorrhage control.
  • Findings support the implementation of standardized pediatric equipment, targeted training for hemorrhagic shock management, and tailored protocols for pediatric patients in conflict settings.
Abstract

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