title: Isolated pediatric burn injury in Iraq and Afghanistan.
abstract: OBJECTIVE
  To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  U.S. military combat support hospitals and forward surgical hospitals in Iraq and Afghanistan.
  
  
  METHODS
  Iraqi and Afghan children less than 18 years old admitted with isolated burn injury.
  
  
  METHODS
  None.
  
  
  RESULTS
  Burn severity was classified as mild, moderate, and severe based on external Abbreviated Injury Scale score. Patient characteristics and outcomes were described according to burn severity. A multivariate logistic regression was performed on univariate associations with mortality. Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury. Overall mortality was 13%, median external Abbreviated Injury Scale was 3 (interquartile range, 2-4), and 67% were male. Variables included in the logistic regression were external Abbreviated Injury Scale score, abnormal heart rate for age, hypotension, mechanical ventilation, transfusion, Glasgow Coma Scale, international normalized ratio, base deficit, hematocrit, and platelet count. Factors independently associated with mortality were international normalized ratio (odds ratio, 2.6; 95% CI, 1.2-5.8; p = 0.021) and external Abbreviated Injury Scale (odds ratio, 2.5; 95% CI, 1.3-4.7; p = 0.004). Mortality increased with burn severity: mild 1.7%, moderate 7.2%, and severe 47% (p < 0.001).
  
  
  CONCLUSIONS
  This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.
authors.affiliation: 1Department of Pediatrics, San Antonio Military Medical Center, Fort Sam Houston, TX. 2Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Borgman
authors.forename: Renée I
authors.initials: RI
authors.lastname: Matos
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D002056:Burns / Q000175:diagnosis / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008887:Military Medicine; D012189:Retrospective Studies; D014481:United States