title: Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan.
abstract: BACKGROUND
  The North Atlantic Treaty Organization (NATO) Role 3 Multinational Medical Unit (R3-MMU) is a tertiary care trauma facility that receives casualties, both coalition and civilian, and provides humanitarian medical assistance when able to the Kandahar province in southern Afghanistan. We examined the cohort of pediatric patients evaluated at the facility during a 16-month period to determine the characteristics and care requirements of this unique patient population.
  
  
  METHODS
  A database of Afghan patients younger than 18 years of age admitted to the NATO R3-MMU between January 2010 and April 2011 was developed from the Joint Theatre Trauma Registry. This patient cohort was analyzed to determine demographics, injury mechanism, injury severity, resource utilization and factors associated with mortality.
  
  
  RESULTS
  A total of 263 children were admitted to the NATO R3-MMU during the study period, representing 12% of all trauma admissions during this time period. The median age was 9 years (range 3 mo-17 yr) with a predominance of male patients (82%). Battle-related trauma was responsible for 62% of admissions, with explosive blast injury constituting the predominant mechanism (42%). The average injury severity score was 12.3 ± 9.3. Overall mortality was 8%. Factors associated with increased risk of death included admission acidosis, coagulopathy, hypothermia and female sex.
  
  
  CONCLUSIONS
  Children represent a significant proportion of traumatic injuries encountered in a modern war zone; many of them are critically injured. Organizations that provide health care in such environments should be prepared to care for this patient population where their mandates and facilities allow for it.
authors.affiliation: Canadian Forces Health Services, Ottawa, Ont. and the Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ont.
authors.forename: Dylan
authors.initials: D
authors.lastname: Pannell
authors.affiliation: Division of General Surgery, Hospital for Sick Children, Toronto, Ont.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Poynter
authors.affiliation: Division of General Surgery, Hospital for Sick Children, Toronto, Ont.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
authors.affiliation: Canadian Forces Health Services, Ottawa, Ont., the Division of General Surgery, Sunnybrook Health Sciences Centre, and the Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ont.
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
authors.affiliation: The Division of General Surgery, Sunnybrook Health Sciences Centre, and the Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ont.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.affiliation: Rady Children's Hospital, University of California, San Diego, San Diego, Calif.
authors.forename: David
authors.initials: D
authors.lastname: Shellington
mesh_terms: D000293:Adolescent; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D001753:Blast Injuries / Q000175:diagnosis / Q000401:mortality*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008887:Military Medicine; D012189:Retrospective Studies; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality