title: Pediatric Surgical Care in a Dutch Military Hospital in Afghanistan.
abstract: BACKGROUND
  From August 2006-August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civilians, including many children. Humanitarian aid accounted for a substantial part of the workload, necessitating medical, infrastructural, and logistical adaptations. Particularly pediatric care demanded specific expertise and equipment. In our pre-deployment preparations this aspect had been undervalued. Because these experiences could be influential in future mission planning, we analyzed our data and compared them with international reports.
  
  
  METHODS
  This is a retrospective, descriptive study. Using the hospital's electronic database, all pediatric cases, defined as patients <17 years of age, who were admitted between August 2006 and August 2010 to the Dutch R2E-MTF at Multinational Base Tarin Kowt (MBTK), Urzugan, Afghanistan were analyzed.
  
  
  RESULTS
  Of the 2736 admissions, 415 (15.2 %) were pediatric. The majority (80.9 %, 336/415) of these admissions were for surgical, often trauma-related, pathology and required 610 surgical procedures, being 26 % of all procedures. Mean length of stay was 3.1 days. The male to female ratio was 70:30. Girls were significantly younger of age than boys. In-hospital mortality was 5.3 %.
  
  
  CONCLUSIONS
  Pediatric patients made up a considerable part of the workload at the Dutch R2E-MTF in Uruzgan, Afghanistan. This is in line with other reports from the recent conflicts in Iraq and Afghanistan, but used definitions in reported series are inconsistent, making comparisons difficult. Our findings stress the need for a comprehensive, prospective, and coalition-wide patient registry with uniformly applied criteria. Civilian disaster and military operational planners should incorporate reported patient statistics in manning documents, future courses, training manuals, logistic planning, and doctrines, because pediatric care is a reality that cannot be ignored.
authors.affiliation: Royal Netherlands Navy (R) and Division of Surgery, Department of Trauma Surgery, MC Haaglanden - Bronovo, Lijnbaan 32, 2512 VA, Den Haag, The Netherlands, f.idenburg@mchaaglanden.nl.
authors.forename: Floris J
authors.initials: FJ
authors.lastname: Idenburg
authors.forename: Thijs T C F
authors.initials: TT
authors.lastname: van Dongen
authors.forename: Edward C T H
authors.initials: EC
authors.lastname: Tan
authors.forename: Jaap H
authors.initials: JH
authors.lastname: Hamming
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.forename: Rigo
authors.initials: R
authors.lastname: Hoencamp
mesh_terms: D000293:Adolescent; D000346:Afghanistan / Q000453:epidemiology; D000533:Altruism; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006772:Hospitals, Military / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008887:Military Medicine / Q000379:methods; D009426:Netherlands; D012189:Retrospective Studies; D016526:Workload / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery