Citation

Sokol KK, Black GE, Azarow KS, Long W, Martin MJ, Eckert MJ. J. Trauma Acute Care Surg. 2015; 79(6): 983-990.

Affiliation

From the Department of Surgery (K.K.S., G.E.B., M.J.M., M.J.E.), Madigan Army Medical Center, Tacoma, Washington; and Department of Surgery (K.S.A.), Oregon Health Sciences University; and Trauma and Acute Care Surgery Service (W.L., M.J.M.), Legacy Emanuel Hospital, Portland, Oregon.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000706

PMID

26680137

Abstract

BACKGROUND: The current conflict in Afghanistan has resulted in a high volume of significantly injured pediatric patients. The austere environment has demanded emphasis on prehospital interventions (PHIs) to sustain casualties during transport.

METHODS: The Department of Defense Trauma Registry was queried for all pediatric patients (≤18 years) treated at Camp Bastion from 2004 to 2012. PHIs were grouped by Advanced Trauma Life Support categories into (1) airway (A)-intubation or surgical airway; 2) breathing (B)-chest tube or needle thoracostomy; and 3) circulation (C)-tourniquet or hemostatic dressing. Outcomes were assessed based on injury severity, hemodynamics, blood products and fluids, as well as mortality rates.

RESULTS: There were 766 injured children identified with 20% requiring one or more PHIs, most commonly circulation (C, 51%) followed by airway (A, 40%) and breathing (B, 8.7%). The majority of C interventions were tourniquets (85%) and hemostatic dressings (15%). Only 38% of patients with extremity vascular injury or amputation received a C intervention, with a significant reduction in blood products and intravenous fluids associated with receiving a C PHI (both p < 0.05). A interventions consisted of endotracheal intubation for depressed mental status (Glasgow Coma Scale [GCS] score < 8). Among patients with traumatic brain injury, A interventions were associated with higher unadjusted mortality (56% vs. 20%, p < 0.01) and remained independently associated with increased mortality after multivariate adjustment (odds ratio, 5.9; p = 0.001). B interventions were uncommon and performed in only 2% of patients with no recorded adverse outcomes.

CONCLUSION: There is a high incidence of PHIs among pediatric patients with severe wartime injuries. The most common and effective were C PHI for hemorrhage control, which should remain a primary focus of equipment and training. A interventions were most commonly performed in the setting of severe traumatic brain injury but were associated with worse outcomes. B interventions seem safe and effective and may be underused. LEVEL OF EVIDENCE: Care management/therapeutic study, level IV.

Language: en