Surgical interventions for pediatric blast injury: An analysis from Afghanistan and Iraq 2002 to 2010

BACKGROUND Acute blast injury requires aggressive operative intervention. This study documents therapeutic procedures required for children with blast injury in Afghanistan and Iraq from 2002 to 2010 at US military treatment facilities, to understand pediatric operative resources required after explosions. METHODS The Joint Theatre Trauma Registry provides data for the previously mentioned population. The data were stratified by years of age as follows: 0 to 3, 4 to 8, 9 to 14, 15 to 19, older than 19 years. Therapeutic procedures were defined by DRG International Classification of Diseases9th Rev. codes 0 to 86.99. These were analyzed by age, body region, and Abbreviated Injury Scale (AIS) score. RESULTS A total of 5,026 patients with a known age requiring a total of 22,677 therapeutic procedures were analyzed; 25% (n = 1,205) were children 14 years or younger. On average, 4.5 procedures were required per patient and varied significantly by age. Soft tissue debridement, vascular access procedure, laparotomy, and thoracostomy were the most common procedures for all ages. For all body regions, severe injury (AIS score 3) was associated with an increased need for an invasive procedure (30-90%) in that region. Children 9 years to 14 years of age underwent significantly more procedures on average (5 procedures per patient) compared with adults (4.5 procedures per patient); children 3 years and younger underwent significantly less (3.15 procedures per patient). Children 4 years to 14 years of age were more likely than older patients to undergo a procedure for a severe head injury (40% vs. 29%), and those 9 years to 14 years old were more likely to undergo a procedure for severe thoracic injury (72%). After 4 years of age, procedures trend away from the head toward the extremity and amputation. CONCLUSION Blast-injured children require significant operative resources during the acute phase of injury. In the event of an explosive attack, pediatric operative resources and expertise are required. LEVEL OF EVIDENCE Epidemiologic study, level III.