title: Wartime vascular injuries in the pediatric population of Iraq and Afghanistan: 2002-2011.
abstract: BACKGROUND
  Contemporary war-related studies focus primarily on adults with few reporting the injuries sustained in local pediatric populations. The objective of this study is to characterize pediatric vascular trauma at US military hospitals in wartime Iraq and Afghanistan.
  
  
  METHODS
  Review of the Department of Defense Trauma Registry (DoDTR) (2002-2011) identified patients (1-17 years old) treated at US military hospitals in Iraq and Afghanistan using ICD-9 and procedure codes for vascular injury.
  
  
  RESULTS
  US military hospitals treated 4402 pediatric patients between 2002 and 2011. One hundred fifty-five patients (3.5%) had a vascular injury. Mean age, gender, and injury severity score (ISS) were 11.1 ± 4.1 years, 79% male, and 34 ± 13.5, respectively. Vascular injuries were primarily from penetrating mechanisms (95.6%; 58.0% blast injury) to the extremity (65.9%), torso (25.4%), and neck (8.6%). Injuries were ligated (31%), reconstructed (63%), or observed (2%). Limb salvage rate was 95%. Mortality rate was 9%.
  
  
  CONCLUSIONS
  This study is the first to report vascular trauma in a pediatric population at wartime. Vascular injuries involve a high percentage of extremity and torso wounding. Torso vascular injury in children is four times lethal relative to other injury patterns, and therefore should be considered in operational planning both in the military and civilian setting regarding pediatric vascular injuries.
authors.affiliation: 59 MDW Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX 78236, USA; United States Army Institute of Surgical Research, San Antonio, TX, USA. Electronic address: cvillamaria@gmail.com.
authors.forename: Carole Y
authors.initials: CY
authors.lastname: Villamaria
authors.affiliation: United States Army Institute of Surgical Research, San Antonio, TX, USA. Electronic address: jjmorrison@outlook.com.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: CSTARS, St. Louis University, St. Louis, MO, USA. Electronic address: colleen.fitzpatrick@amedd.army.mil.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Fitzpatrick
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX 78234-6315, USA; Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address: jcannon@massmed.org.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Cannon
authors.affiliation: 59 MDW Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX 78236, USA; United States Army Institute of Surgical Research, San Antonio, TX, USA. Electronic address: todd.e.rasmussen.mil@mail.mil.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001753:Blast Injuries / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000293:injuries / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D007813:Laparotomy / Q000706:statistics & numerical data; D023821:Limb Salvage / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008952:Mobile Health Units / Q000706:statistics & numerical data; D019838:Neck Injuries / Q000453:epidemiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data; D060726:Torso / Q000293:injuries / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery
keywords: Children; Pediatric; Reconstruction; Trauma; Vascular injury; Wartime