title: Pediatric trauma in an austere combat environment.
abstract: 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.
  
  
  METHODS
  The authors provide a descriptive report.
  
  
  METHODS
  This study was conducted at seven combat support hospitals in both Iraq and Afghanistan.
  
  
  METHODS
  Subjects were pediatric patients age <18 yrs.
  
  
  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.
authors.affiliation: Department of Pediatrics (PCS), Connecticut Children's Medical Center, Hartford, CT, USA. pspinella@ccmckids.org
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Mathew A
authors.initials: MA
authors.lastname: Borgman
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Azarow
mesh_terms: D000293:Adolescent; D000346:Afghanistan / Q000453:epidemiology; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006302:Health Services Research; D017052:Hospital Mortality; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008507:Medically Underserved Area; D008887:Military Medicine / Q000458:organization & administration*; D009936:Organizational Innovation; D010343:Patient Admission / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration; D014218:Triage / Q000458:organization & administration; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*