Pediatric Blast Trauma: A Systematic Review and Meta-Analysis of Factors Associated with Mortality and Description of Injury Profiles

Abstract

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.

Pediatric traumatic brain injuries in war zones: a systematic literature review

“…It is difficult to detail the characteristics of TBIs in every study, given that the scale used to represent the trauma is inconsistent and varies depending on the study. Additionally, most studies include “head trauma” or “head injury” as part of their TBI reports, even when the injuries range from minor bruises to injuries requiring neurosurgical consultation, making a detailed analysis of the TBIs difficult ( 5 ).…”

“…The immediate effects of pediatric TBI in war zones can be life-threatening. Children may suffer from loss of consciousness, seizures, and respiratory difficulties, requiring urgent medical attention ( 4 , 5 ).…”

Newborns and Children in War and Terror

“…A meta-analysis including 38 studies on war and terror described 222,638 recorded paediatric injuries between 2000 and 2021. Of these, 19,879 were related to terrorism [ 10 ]. Paediatric victims compared to adult civilians had a different blast injury profile with more injuries in the head, face, and neck region.…”

“…Mortality was 15.4% related to terrorist explosion versus 5.2% of explosions unrelated to terrorism. Infants with an open cranial fontanelle are especially prone to head injuries and potentially more vulnerable to traumatic intracranial pathology [ 10 ].…”