Blast injury in children

Edwards, Mary J.; Lustik, Michael B.; Eichelberger, Martin R.; Elster, Eric A.; Azarow, Kenneth S.; Coppola, Christopher P.

doi:10.1097/ta.0b013e318270d3ee

Cited by 81 publications

(30 citation statements)

References 16 publications

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“…[5] Edwards et al in their study of 4,983 blast injury among civilian patients in Afghanistan and Iraq; in this cohort, 25% were children younger than 15 years and also reported that injuries in children were more likely to occur in the head and neck and less likely in the bony pelvis (perineum) and extremities. [13] This is corroborated by the findings in other studies. [6,7] Blast injuries tend to affect multiple parts of the body.…”

Section: Discussionsupporting

confidence: 85%

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Paediatric perineal injury following explosive blast: A Case Report

Nwashilli¹,

Arekhandia²

2020

Ann Health Res

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Perineal injury in children is uncommon. Injuries range from minor perineal skin laceration to severe injury to the genitourinary tract, anorectal region and the pelvic bone. The mechanisms of injury are usually attributed to blunt trauma, penetrating injuries like impalement injury, or sexual abuse. Perineal injury resulting from explosive blast in children is rare. The management depends on the time and mode of presentation and examination findings. Early presentation (a few hours after injury) with 1st or 2nd-degree perineal injury may benefit from debridement with primary repair of soft tissues and/or sphincters. Late presentation (days after injury) with 3rd or 4th-degree injury will require diverting colostomy or urinary diversion and wound drainage. This is a report of an unusual case of severe perineal injury in a child following explosive blast sustained while squatting close to packed explosives that got detonated. The perineal injury was initially managed with colostomy and wound drainage. The colostomy was closed after the wound had healed with good faecal continence achieved and without perineal soft tissue or anal sphincteric repair. It is concluded that severe isolated paediatric explosive blast perineal injury is rare but is amenable to surgical care.

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Section: Discussionsupporting

confidence: 85%

“…Edwards et al in their study of 4983 children presenting with blast injuries reported a mortality rate of 8%. [13] However, Thompson et al reported mortality over double that of Edwards et al (18%). [14] This was attributed to operational tempo and increasing use of improvised explosive devices.…”

Section: Discussionmentioning

confidence: 92%

Paediatric perineal injury following explosive blast: A Case Report

Nwashilli¹,

Arekhandia²

2020

Ann Health Res

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“…18 As such, there exists an ever-evolving definition of pediatric massive transfusion (Table 1). 3,16,17,[19][20][21]…”

Section: Definition Of Massive Transfusion In Childrenmentioning

confidence: 99%

“…Additional etiologies of life-threatening hemorrhage include operative complications, invasive tumors whose removal results in significant blood loss, liver surgery and gastrointestinal bleeding. [3][4][5][6] Despite these varied reasons for hemorrhage, traumatic injury remains the main driver for activation of a pediatric MTP. This subset of trauma victims is generally older, more hypothermic, with a higher injury severity score when compared with other pediatric trauma patients who may have been transfused but did not meet the criteria for pediatric massive transfusion (MT).…”

Section: Introductionmentioning

confidence: 99%

<p>Massive Transfusion Protocols for Pediatric Patients: Current Perspectives</p>

Evangelista¹,

Gaffley²,

Neff³

2020

JBM

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In adults, the use of balanced resuscitation and study of massive transfusion protocols have led to improved outcomes for patients and continues to be refined. In children, massive transfusion protocols require further development and study to assess efficacy. Standardization is needed as transfusions and activation of protocols still rely on physician discretion in most pediatric settings. Further research is required to define the pediatric trauma population that will benefit, when to activate these protocols and how to use adjuncts such as tranexamic acid or factor VII in resuscitation. In addition, future implementation of technology such as hemoglobin-based oxygen carriers to increase survival should be studied further in this subset of patients.

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“…Comparison of paediatric wartime mortality data is difficult as many studies do not differentiate mechanism of injury. Edwards et al ’s41 study on 4913 children between 2002 and 2010 presenting with blast injuries remains the single largest data set. The reported mortality rate of 8% matches well with the mortality rates of 6%–9% quoted in paediatric trauma deaths from Iraq and Afghanistan, although these studies displayed all trauma mechanisms as opposed to specifying blast trauma 35 42–46.…”

Section: Resultsmentioning

confidence: 99%

Blast injuries in children: a mixed-methods narrative review

Hargrave

Pearce

Mayhew

et al. 2019

bmjpo

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Background and significanceBlast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.MethodsIn this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.ResultsChildren affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.ConclusionsCertain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.

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Blast injury in children

Abstract: Epidemiologic study, level III.

Cited by 81 publications

References 16 publications

Paediatric perineal injury following explosive blast: A Case Report

Paediatric perineal injury following explosive blast: A Case Report

<p>Massive Transfusion Protocols for Pediatric Patients: Current Perspectives</p>

Blast injuries in children: a mixed-methods narrative review

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