title: Pediatric inpatient humanitarian care in combat: Iraq and Afghanistan 2002 to 2012.
abstract: BACKGROUND
  The purpose of this study was to define the scope of combat- and noncombat-related inpatient pediatric humanitarian care provided from 2002 to 2012 by the United States (US) Military in Iraq and Afghanistan.
  
  
  METHODS
  A review of the Patient Administration Systems and Biostatistics Activity (PASBA) database for all admissions from 2002 to 2012 by US military hospitals in Afghanistan and Iraq for children 14 years of age and younger provided data to analyze the use of medical care. North Atlantic Treaty Organization Standardization Agreement (STANAG) injury codes provided injury cause and the ICD-codes provided diagnosis. In-hospital mortality, blood usage, number of invasive procedures, and hospital stay were analyzed by country and injury category.
  
  
  RESULTS
  There were 6,273 admissions that met inclusion criteria. In Afghanistan, there were more than twice as many pediatric noncombat-related admissions (2,197) as pediatric combat-related admissions (1,095). In Iraq, the difference was minimal (1,391 noncombat vs 1,590 combat). The most common cause of noncombat-related admission in both countries was injury: primarily motor vehicle related and burns, which varied significantly by age. Older patients (older than 8 years in Afghanistan and older than 4 years in Iraq) were more likely combat victims. Mortality was highest for combat trauma in Iraq (11%) and noncombat trauma in Afghanistan (8%). The in-hospital mortality in both countries was 5% for admissions unrelated to trauma. Resource use was highest for combat trauma in both countries.
  
  
  CONCLUSIONS
  Noncombat-related medical care was the primary reason for pediatric humanitarian admissions to United States military combat hospitals in Iraq and Afghanistan from 2002 to 2012. Combat-related injuries have a higher mortality than noncombat injuries or other admissions.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, TAMC, HI. Electronic address: mary.j.edwards@us.army.mil.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, TAMC, HI.
authors.forename: Michael
authors.initials: M
authors.lastname: Lustik
authors.affiliation: Department of Pediatrics, Tripler Army Medical Center, TAMC, HI.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Burnett
authors.affiliation: Department of Surgery, Children's National Medical Center, Annapolis, MD.
authors.forename: Martin
authors.initials: M
authors.lastname: Eichelberger
mesh_terms: D000293:Adolescent; D055826:Afghan Campaign 2001-; D000533:Altruism; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007297:Inpatients; D054542:Iraq War, 2003-2011; D007902:Length of Stay / Q000639:trends; D008297:Male; D008887:Military Medicine / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy*