Global surgery for paediatric casualties in armed conflict
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(2019) 14:55
RESEARCH ARTICLE
Open Access
Global surgery for paediatric casualties in armed conflict Frederike J. C. Haverkamp1* , Lisanne van Gennip1, Måns Muhrbeck2,3,4, Harald Veen, Andreas Wladis3,4 and Edward C. T. H. Tan1
Abstract Background: Understanding injury patterns specific for paediatric casualties of armed conflict is essential to facilitate preparations by organizations that provide medical care in conflict areas. The aim of this retrospective cohort study is to identify injury patterns and treatment requirements that are specific for paediatric patients in conflict zones. Methods: Characteristics of children (age < 15 years) treated in medical facilities supported by the International Committee of the Red Cross (ICRC) between 1988 and 2014 in Kabul, Kao-i-Dang, Lokichogio, Kandahar, Peshawar, Quetta and Goma were analysed; patient characteristics were compared between treatment facilities and with those of adult patients (age ≥ 15 years). Results: Of the patients listed in the database, 15% (5843/38,088) were aged < 15 years. The median age was 10 years (IQR 6–12); 75% (4406/5843) were male. Eighty-six percent (5012/5,843) of the admitted children underwent surgery, with a median of 2 surgeries per patient (IQR 1–3). When compared with adult patients, children were more frequently seen with fragment injuries, burns and mine injuries; they had injuries to multiple body regions more often and had higher in-hospital mortality rates. Conclusions: Children more often sustained injuries to multiple body regions and had higher in-hospital mortality than adults. These findings could have implications for how the ICRC and other organizations prepare personnel and structure logistics to meet the treatment needs of paediatric victims of armed conflicts. Keywords: Paediatric trauma, Humanitarian aid, Global health
Introduction The impact of war on children’s lives is extensive [1–4]. In conflict, the paediatric workload in military hospitals is 6% of all patients[5–10], and an even greater portion of paediatric patients (18%) is treated in humanitarian hospitals [11, 12]. Additionally, the percentage of paediatric patients is markedly higher among the surgical patient population in military hospitals (16%) [13, 14] as well as in humanitarian efforts (30%) [15–19], which again emphasizes that war-wounded children demand extensive care and resources [5, 8–10, 13, 20–24]. Additionally, younger age (≤ 8 years) has been independently associated with mortality
* Correspondence: [email protected] 1 Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands Full list of author information is available at the end of the article
in trauma patients admitted to combat support hospitals in Iraq and Afghanistan [9, 10, 22]. Given this context, it is of value to note that predeployment military medical training did not seem to fully meet the educational needs of their deployed personnel in the treatment of paediatric patients [25–27]. Our research group recently perf
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