Injury severity and functional outcome following paediatric trauma in war conditions

Abstract

Trauma causes substantial morbidity and functional impairments among children. The aim of this study was to investigate injuries of children, type of injuries, injury severity, functional impairments and relation between functional impairments and mechanisms of severe injuries in children following trauma in war conditions. This study followed 193 children with trauma, aged 1-16 years, who were admitted and treated in a regional rehabilitation centre from 1992-1995. The degree of injury seriousness was determined according to Injury Severity Scores (ISS). Functional status was measured by means of the own functional assessment scale. Higher ISS was noted for severe injuries caused by firearms than by other means. There was significantly minor functional recovery in children with firearms severe trauma at discharge than with other types of severe injuries (t = 2.04, p < 0.05). The number of all paediatric trauma and firearms injuries decreased by length of war duration. ISS and functional status in children injured by fall at the discharge also decreased. These results show that there are direct and long-term consequences in children age, especially in children with severe traumas caused by firearms, and indicate assessment of psychosocial status of each injured child together with severity of injury.

Violence-related injury of children in Israel: age-dependent pattern

“…13,14 The risk of sustaining a severe injury was most closely associated with the use of firearms. Literature on the subject supports this finding 15 and underlines the urgent need to confiscate unlicensed firearms and to introduce compulsory behavioural training for licensed gun owners. 16,17 …”

Pediatric trauma: experience of a combat support hospital in Iraq

“…As we observed, a high percentage suffer penetrating injuries (gunshot wounds and fragmentation wounds), burns, and blast injuries [2,[4][5][6]. These injuries tend to be associated with a higher ISS and worse functional outcome than other types of injuries [6]. Victims of gunshot wounds are 6 times more likely to die than victims of a car crash [7].…”

Analysis of pediatric trauma score in patients wounded with shrapnel effect of explosives with high kinetic energy: Results of the first intervention center.

“…Ancak, erişkinlerle çocuklar arasında anatomik ve fizyolojik farkların olması özgün yaklaşımları gerektirmiştir. [4,5] Parça etkili patlayıcılar ile gerçekleşen ateşli silah yaralanmaları çatışma ortamları dışında günümüzde kitleleri hedef seçen terör olayların artması nedeni ile sivil ortamlarda da görülmektedir. Bununla birlikte pediatrik olgularda bu tür yaralanmalar oldukça nadirdir.…”

“…[5,7] Çalışmamızda, PTS ≤8 olan olgulardaki HKS anlamlı derecede yüksek bulunması morbidite oranlarıyla doğrudan ilişkili olduğunu düşünmekteyiz. Ayrı-ca PTS >8 ve ≤8 olan olgularımızdaki nabız farkının istatistiksel olarak anlamlı bulunmasını skor hesaplanırken kriterler içerisinde sistolik tansiyonun bir parametre olarak kullanılmasıyla ile ilişkilendirdik.…”

“…Serimize ait bu veriler diğer çalışmalara ait sonuçlar ile uyumludur. [4,5,7,8] Sonuç olarak, PTS parça etkili patlayıcı yaralanmalarında travmanın değerlendirilmesinde oldukça etkin ve zaman kazandırıcıdır. PTS ile değerlendirilmiş yüksek kinetik enerjiye sahip parça etkili yaralanmalar analiz edildiğinde, PTS ≤8 olan olgularda nabız ortancası, morbidite ve HKS belirgin olarak artmaktadır.…”