Pediatric trauma in an austere combat environment.

OBJECTIVE: The objective of this study was to describe the epidemiology of pediatric patients admitted with traumatic injuries to U.S. combat support hospitals and to provide insight into both critical care and noncritical care challenges this presents. DESIGN: The authors provide a descriptive report. SETTING: This study was conducted at seven combat support hospitals in both Iraq and Afghanistan. PATIENTS: Subjects were pediatric patients age <18 yrs. MEASUREMENTS AND MAIN RESULTS: There were 1,305 (7.1%) pediatric patients admitted to Army combat support hospitals who required 12% of all hospital bed days. The hospital length of stay was increased in pediatric patients compared with both adult coalition and noncoalition patients. Thirteen percent of all the patients who died at combat support hospitals and 11% of all transfusions and patients on mechanical ventilation were children. In-hospital mortality for pediatric patients was increased 71 of 1,305 (5.4%) compared with both adult coalition (114 of 8,567 [1.3%]) and noncoalition patients (369 of 8,511 [4.3%]) (p < .05). In-hospital mortality was increased for children <6 yrs of age compared with children 6 to 17 yrs of age, 10.7% versus 3.8%, respectively (p < .05). CONCLUSIONS: Pediatric patients with traumatic injuries are common at deployed U.S. military medical facilities as a result of combat-related and noncombat-related injuries and have increased in-hospital mortality compared with adults. Mortality was also increased for younger compared with older children. Innovative adaptations in addition to logistic and organizational changes have potentially improved pediatric care since the early stages of both wars from 2001 to 2003. Self-improvement through coalition support of the Iraqi and Afghani medical systems is needed to permit advancement and self-reliance.