Analysis of Pediatric Trauma in Combat Zone to Inform High-Fidelity Simulation Predeployment Training*

Reeves, Patrick T.; Auerbach, Marc; Le, Tuan; Caldwell, Nicole; Edwards, Mary J.; Mann-Salinas, Elizabeth; Gurney, Jennifer M; Stockinger, Zsolt T.; Borgman, Matthew A.

doi:10.1097/pcc.0000000000001461

Cited by 9 publications

(13 citation statements)

References 29 publications

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“…All studies included within this review use data from military trauma databases which have their own limitations. Firstly, a combat medical environment can be high-pressured and understaffed hence documenting information can be difficult and multiple studies 3,32,42 highlight the issue of missing values in the data. Secondly, the DoDTR, used by most studies, does not document the extent to which blood product resuscitation was guided by test results.…”

Section: Discussionmentioning

confidence: 99%

“…Gale et al 34 and Reeves et al 42 studied larger patient populations (1,955 and 1,318, respectively) over several years (9 and 6 years, respectively). The study by Reeves et al 42 did have limitations: the database used did not document patient weights thus they could not be used to calculate missing ages which limited the analysis of the study. From these studies, it cannot be determined which age group was most severely injured and required the largest volume of blood products.…”

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

“…35 Some studies report that older children were more severely injured and were more likely to receive blood products. Reeves et al 42 found that in Afghanistan the >8 years age group had the largest proportion of patients that received PRBCs (22%) as well as crystalloids (75%). Gale et al 34 demonstrated that the use of each blood component within ITU increased with age, with all blood products most frequently used in the 10-14 age group.…”

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

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A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Wright

Ramage

Barratt

et al. 2023

Trauma

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Introduction Requirement for blood transfusion in the injured paediatric civilian population is rare. Therefore, a substantial evidence base underpinning damage control resuscitation (DCR) in paediatric patients is lacking. Published outcome data originating from Iraq and Afghanistan offer a unique opportunity to study large cohorts of children who received DCR. It is hoped that by collating the data, this review will inform pre-deployment medical training and support the development of paediatric specific DCR guidelines, which can be used in all trauma environments. Methodology A comprehensive search of the literature was conducted using online databases, grey literature searching and screening of reference lists. Papers discussing blood product, crystalloid or tranexamic acid (TXA) administration in paediatric patients injured in Iraq and Afghanistan from 2001to present were included. Results Eighteen papers were included – all were retrospective studies of data from military trauma databases. Most children that received massive transfusion were male (73.4%), injured in Afghanistan (69.9%) by explosives (60.4%) with a median age of 9 years. A definition of paediatric massive transfusion of 40 ml/kg of all blood products within 24 h was developed. Massive transfusion rates were high (15.7% of children). Whole blood administration occurred in 4% of patients requiring blood transfusions. Low crystalloid volumes in combination with balanced blood product ratios were associated with improved survival, along with the use of whole blood and TXA. Conclusion The review offers insight into the paediatric population likely to require DCR and the optimal DCR strategies to be used in their management.

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Section: Discussionmentioning

confidence: 99%

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

Section: Demographics Of Paediatric Trauma Patientsmentioning

confidence: 99%

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A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Wright

Ramage

Barratt

et al. 2023

Trauma

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“…Children are more commonly injured by blast or blunt force mechanisms, with extremity trauma being a dominant injury pattern. Figure 1 graphically demonstrates the frequency of the different injury types as described by studies from various regions [2,3,[11][12][13][14][15]. Additionally, a prospective study at Camp Bastion, Afghanistan, provided detailed descriptions of pediatric trauma patients, and demonstrated over 75% of traumatic injuries were distributed to the extremities and head and neck regions [11].…”

Section: Epidemiology Of Pediatric Trauma During Armed Conflictmentioning

confidence: 99%

“…1 (A) International Committee of the Red Cross reported injury types from pediatric patients at hospitals throughout the world had burns 1.8%, gunshot wounds (penetrating injury) 32.6%, and blast injuries 55.4% [8]. (B) Pediatric patients in Afghanistan from 2008 to 2014 had penetrating injuries 56%, blunt injuries 33%, and burns 7% [15]. (C) Experience from 10 years of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF): blast injuries 37%, penetrating injuries 27%, blunt injuries 23%, and burns 13% [3].…”

Section: Infectious Complications Of Combat Traumamentioning

confidence: 99%

Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

Cirks

Rajnik

Madden

et al. 2021

Curr Infect Dis Rep

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Purpose of Review Children in many regions face the daily threat of injury from armed conflict. The direct effects of combat trauma have led to many morbidities in survivors, including a variety of infectious complications. Contemporary experiences from recent military operations have advanced combat casualty care and concurrently informed the care of civilian combat trauma. Unfortunately, there is a lack of data to correlate the impact armed conflict has on the specific risks for infection in pediatric casualties. We review modern literature and apply data from adult casualties to pediatric combat trauma features to form management considerations and identify future research needs. Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrug-resistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources to assist in the management of infectious complications of direct injury to children in armed conflict regions are provided. Recent FindingsWe review the recent literature with an emphasis on publications over the past decade, apply data from adult casualties to pediatric combat trauma features to form management considerations, and identify future research needs. Summary Children require a disproportionately high number of resources when injured, and recently developed pediatric injury severity scoring systems can be predictive of potential outcomes. Blast injuries are the most common trauma type, and children suffer unique injury patterns with subsequent risks for infections. Experience has shown that mixed injuries, including blasts, penetrating injuries, burns, and the need for massive blood transfusions, can pose unique infectious challenges such as invasive fungal infections. Antimicrobial resistance is a top health priority with combat injuries, as multidrugresistant organisms rapidly emerge in hospitals caring for those injured in conflict. Resources are provided to assist in the management of infectious complications resulting from direct injury to children in armed conflict regions.

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Burn Injuries from a military perspective

2022

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Analysis of Pediatric Trauma in Combat Zone to Inform High-Fidelity Simulation Predeployment Training*

Cited by 9 publications

References 29 publications

A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

Burn Injuries from a military perspective

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