[The spectrum of war-like injuries in children and teenagers during a post-war wave of violence in Iraq].
BACKGROUND
In developing countries, war-like injury involving civilians, including children, is still a relevant and massive health problem and the human and economic costs of the injuries are tremendous.


OBJECTIVE
The aim of this study is to report on the spectrum of war-like injuries and their management in children and teenagers in an Iraqi surgical centre during a post-war wave of violence.


METHODS
All consecutive war-like injuries in children and teenagers younger than 16 years were documented in a clinical observational study (study design: Case series), who were treated during the time period of employment of the reporting author at the Casualty Unit of the University Hospital in Al Kadhimiyia (UHK), Baghdad (Iraq), over a 2-year period. The cases were studied with regard to descriptive criteria such as demographic patient characteristics, cause, site(s), and combination of injuries as well as their surgical management; among other factors, the specialty-depending distribution and outcome characterised by mortality were evaluated. Representative photographs have been selected from the photographic documentation in most cases.


RESULTS
From March 2003 to March 2005, 272 injured children and teenagers aged 16 years or less were enrolled in the study. The injuries in the majority of the casualties were caused by explosions in civilian areas, mortar bombardment of civilian buildings and housing, and family assassinations. The injuries were more common in males with a male to female ratio of 3.1 : 1; 206 (75.7 %) of the casualities were males and 66 (24.3 %) were females. Of the 272 casualties studied, 52 (19.1 %) were 5 years old or less, 95 (34.9 %) were between 6 to 11 years, and 125 (45.9 %) were between 12 to 16 years old. There were 126 (46.3 %) minor casualties, who were managed in the outpatient emergency unit, while 146 (53.6 %) casualties had serious and major injuries, 120 (44.1 %) of whom were admitted to UHK and 6 were transferred to other hospitals. Twenty (7 %) casualties died (12 on arrival and 8 during resuscitation) and two casualties were discharged at their parents demand shortly after admission without receiving adequate medical care. Fragmentation weapons (blast injuries) caused 216 (79.4 %) casualties, 54 (19.8 %) casualties experienced gunshot wounds and 2 (0.7 %) substantial burns. Injuries to the lower limbs and trunk were the most common injuries in this series accounting for 126 (46.3 %) of all injuries.


CONCLUSIONS
There is a considerable risk not only for adolescents but even for children under conditions similar to those of civil war. However, the challenge is to provide an appropriate treatment in spite of the potential severity of injuries. This requires an adequate logistic management, surgical expertise as well as equipment and even the collaboration with surgical centres from supporting countries.
University Hospital, Al-Kadhimiyia UHK, Baghdad, Irak.
D
D
Al-Anbaki
F
F
Meyer
A
A
Edan
H
H
Lippert
D000293:Adolescent; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D001753:Blast Injuries / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D054042:Bombs; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005107:Explosions; D005260:Female; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000401:mortality / Q000601:surgery