Pediatric Combat Trauma

Russo, Rachel M.; Neff, Lucas P.

doi:10.1007/s40719-016-0061-z

Cited by 5 publications

(7 citation statements)

References 56 publications

(42 reference statements)

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“…Borgman et al 6 found that compared with adults, pediatric patients had a significantly worse outcomes with higher Injury Severity Scores (ISS), worse Glasgow Coma Scale (GCS) scores, younger than 8 years, being female, and having burns. The high-resource consumption after burn injuries noted by Borgman was similar to the findings by Gurney et al The age range of children treated spanned 2 days to 18 years old 7 . Children younger than 3 years had the lowest encounter rate, but those 2 years or below had the highest mortality rate (25.1%) 2,8 .…”

Section: Discussionsupporting

confidence: 78%

A scoping review of two decades of pediatric humanitarian care during wartime

Kocik

Borgman

April

et al. 2023

J Trauma Acute Care Surg

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Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting. We sought to perform a scoping review of pediatric research from the recent US-led wars in Afghanistan, and Iraq conflicts beginning in 2001. We used Google Scholar and PubMed to identify pediatric combat literature published between 2001 and 2022. We utilized the PRISMA-ScR Checklist to conduct this review. We identified 52 studies that met inclusion for this analysis—1 prospective observational study, 50 retrospective studies, and 1 case report. All the original research studies were retrospective in nature except for one. We identified one prospective study that was a post hoc subanalysis from an overall study assessing the success of prehospital lifesaving interventions. Most of the articles came from varying registries created by the United States and British militaries for the purposes of trauma performance improvement. The deployed health service support mission often includes treatment of pediatric trauma patients. The deployed health service support mission often includes treatment of pediatric trauma patients. We found that available literature from this setting is limited to retrospective studies except for one prospective study. Our findings suggest that pediatric humanitarian care was a significant source of medical resource consumption within both of the major wars. Further, many of the lessons learned have directly translated into changes in civilian pediatric trauma care practices highlighting the need for collaborative scientific developments between the military and civilian trauma programs. LEVEL OF EVIDENCE Systematic Review/Meta-Analyses; Level III.

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Section: Discussionsupporting

confidence: 78%

A scoping review of two decades of pediatric humanitarian care during wartime

Kocik

Borgman

April

et al. 2023

J Trauma Acute Care Surg

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“…Поранення дітей внаслідок бойових дій не часто описують у наукових публікаціях внаслідок рідкісності таких випадків. Лікування поранених дітей, як показав досвід проведення бойових дій в Іраку й Афганістані, здебільшого потребує умов інтенсивної терапії [1] та високого професіоналізму лікарів [2], адже травми, пов'язані з війною, як правило, є більш тяжкими, ніж у цивільному секторі [3], мають вищу смертність, ніж небойові травми чи інші госпіталізації [4,11].…”

Section: вступunclassified

Current challenges of intensive care in children affected by the war in Ukraine

Filyk

2023

ЕМ

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Background. Treatment of children with combat injuries due to the war in Ukraine requires intensive care and high professionalism. The purpose of study was to demonstrate the experience of providing intensive care to children affected by the war in Ukraine and to discuss the implementation of international standards for providing medical aid to such patients at the stages of evacuation from the war zone. Materials and methods. We have examined and provided intensive care to 15 children aged 1 month — 18 years old with combat injuries due to hostilities in Ukraine. Literature search was performed in PubMed databases using the keywords “combat trauma in children, “blast injuries in children”, “intensive care of children with tertiary peritonitis”, “acute and chronic pain”, “acute psychiatric disorders in children”, “sepsis and septic shock in children”, “multiresistant nosocomial infections”. Results. The main clinical problems of people affected by hostilities were: acute and chronic pain, acute psychiatric disorders (psychosis, hallucinatory syndrome, agitation), sepsis and colonization by multiresistant nosocomial pathogens, especially if a patient was previously treated in the intensive care unit for more than 2 weeks (pneumonia, wound infections), gastrointestinal failure syndrome, gastroparesis, tertiary peritonitis, nutrient deficiency, prolonged mechanical ventilation and difficulty weaning from it. All patients received multidisciplinary care. Conclusions. Thus, our experience of treating children requiring intensive care after war injuries indicates that such patients have a combination of many clinical problems already known to clinicians, which are typical for both long-term intensive care patients, and those with severe injuries.

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“…The use of adult equipment is often necessary, and despite limitations it may still achieve good results. Reports from military medical teams in Afghanistan and Iraq demonstrated good control of traumatic haemorrhage in children when using adult-sized tourniquets and full-dose tranexamic acid in lieu of paediatric equipment and dosing regimens 5. Access to paediatric-specific equipment remains preferable, however, and ensures the best possible care can be delivered without needing to use improvised solutions.…”

Section: Interventionsmentioning

confidence: 99%

“…For example, the surgical approach in US military field hospitals for those presenting with mangled lower extremities during conflicts in Iraq and Afghanistan was influenced by the long-term care that was likely to be available to the patient. US service personnel usually had better outcomes following early amputation as they had ongoing rehabilitation available to them; however, the treatment for local children presenting with similar injuries was focused on limb salvage 5. One review considered 16 papers published by various civilian and military surgical teams that treated children and adults following a range of disasters between 1990 and 2018 8.…”

Section: Interventionsmentioning

confidence: 99%

Children in a disaster: health protection and intervention

Reid¹,

Hillman

2022

BMJ Mil Health

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Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

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Pediatric Combat Trauma

Cited by 5 publications

References 56 publications

A scoping review of two decades of pediatric humanitarian care during wartime

A scoping review of two decades of pediatric humanitarian care during wartime

Current challenges of intensive care in children affected by the war in Ukraine

Children in a disaster: health protection and intervention

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