Skip to main content
Top
Published in: World Journal of Emergency Surgery 1/2019

Open Access 01-12-2019 | Research article

Global surgery for paediatric casualties in armed conflict

Authors: Frederike J. C. Haverkamp, Lisanne van Gennip, Måns Muhrbeck, Harald Veen, Andreas Wladis, Edward C. T. H. Tan

Published in: World Journal of Emergency Surgery | Issue 1/2019

Login to get access

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.
Literature
1.
go back to reference Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374(9693):881–92.CrossRef Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374(9693):881–92.CrossRef
2.
go back to reference Celikel A, Karbeyaz K, Kararslan B, Arslan MM, Zeren C. Childhood casualties during civil war: Syrian experience. J Forensic Leg Med. 2015;34:1–4.CrossRef Celikel A, Karbeyaz K, Kararslan B, Arslan MM, Zeren C. Childhood casualties during civil war: Syrian experience. J Forensic Leg Med. 2015;34:1–4.CrossRef
3.
go back to reference Afghan civilian casualties: a grim reality. Lancet. 2013;382(9891):480. Afghan civilian casualties: a grim reality. Lancet. 2013;382(9891):480.
4.
go back to reference Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet. 2018. Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet. 2018.
5.
go back to reference Heller D. Child patients in a field hospital during the 2003 Gulf conflict. J R Army Med Corps. 2005;151(1):41–3.PubMed Heller D. Child patients in a field hospital during the 2003 Gulf conflict. J R Army Med Corps. 2005;151(1):41–3.PubMed
6.
go back to reference Beitler AL, Wortmann GW, Hofmann LJ, Goff JM Jr. Operation enduring freedom: the 48th Combat Support Hospital in Afghanistan. Mil Med. 2006;171(3):189–93.CrossRef Beitler AL, Wortmann GW, Hofmann LJ, Goff JM Jr. Operation enduring freedom: the 48th Combat Support Hospital in Afghanistan. Mil Med. 2006;171(3):189–93.CrossRef
7.
go back to reference Burnett MW, Spinella PC, Azarow KS, Callahan CW. Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004. Pediatrics. 2008;121(2):261–5.CrossRef Burnett MW, Spinella PC, Azarow KS, Callahan CW. Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004. Pediatrics. 2008;121(2):261–5.CrossRef
8.
go back to reference Idenburg FJ, van Dongen TT, Tan EC, Hamming JH, Leenen LP, Hoencamp R. Pediatric surgical care in a Dutch Military Hospital in Afghanistan. World J Surg. 2015;39(10):2413–21.CrossRef Idenburg FJ, van Dongen TT, Tan EC, Hamming JH, Leenen LP, Hoencamp R. Pediatric surgical care in a Dutch Military Hospital in Afghanistan. World J Surg. 2015;39(10):2413–21.CrossRef
9.
go back to reference Spinella PC, Borgman MA, Azarow KS. Pediatric trauma in an austere combat environment. Crit Care Med. 2008;36(7 Suppl):S293–6.CrossRef Spinella PC, Borgman MA, Azarow KS. Pediatric trauma in an austere combat environment. Crit Care Med. 2008;36(7 Suppl):S293–6.CrossRef
10.
go back to reference Borgman M, Matos RI, Blackbourne LH, Spinella PC. Ten years of military pediatric care in Afghanistan and Iraq. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S509–13.CrossRef Borgman M, Matos RI, Blackbourne LH, Spinella PC. Ten years of military pediatric care in Afghanistan and Iraq. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S509–13.CrossRef
11.
go back to reference Andersson P, Muhrbeck M, Veen H, Osman Z, von Schreeb J. Hospital workload for weapon-wounded females treated by the International Committee of the Red Cross: more work needed than for males. World J Surg. 2018;42(1):93–8.CrossRef Andersson P, Muhrbeck M, Veen H, Osman Z, von Schreeb J. Hospital workload for weapon-wounded females treated by the International Committee of the Red Cross: more work needed than for males. World J Surg. 2018;42(1):93–8.CrossRef
12.
go back to reference Bitterman Y, Benov A, Glassberg E, Satanovsky A, Bader T, Sagi R. Role 1 Pediatric trauma care on the Israeli-Syrian border-first year of the humanitarian effort. Mil Med. 2016;181(8):849–53.CrossRef Bitterman Y, Benov A, Glassberg E, Satanovsky A, Bader T, Sagi R. Role 1 Pediatric trauma care on the Israeli-Syrian border-first year of the humanitarian effort. Mil Med. 2016;181(8):849–53.CrossRef
13.
go back to reference Hoencamp R, Tan EC, Idenburg F, Ramasamy A, van Egmond T, Leenen LP, et al. Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg. 2014;40(4):421–8.CrossRef Hoencamp R, Tan EC, Idenburg F, Ramasamy A, van Egmond T, Leenen LP, et al. Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg. 2014;40(4):421–8.CrossRef
14.
go back to reference Farrow GB, Rosenfeld JV, Crozier JA, Wheatley P, Warfe P. Military surgery in Rwanda. Aust N Z J Surg. 1997;67(10):696–702.CrossRef Farrow GB, Rosenfeld JV, Crozier JA, Wheatley P, Warfe P. Military surgery in Rwanda. Aust N Z J Surg. 1997;67(10):696–702.CrossRef
15.
go back to reference Trelles M, Stewart BT, Hemat H, Naseem M, Zaheer S, Zakir M, et al. Averted health burden over 4 years at Medecins Sans Frontieres (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015. Surgery. 2016;160(5):1414–21.CrossRef Trelles M, Stewart BT, Hemat H, Naseem M, Zaheer S, Zakir M, et al. Averted health burden over 4 years at Medecins Sans Frontieres (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015. Surgery. 2016;160(5):1414–21.CrossRef
16.
go back to reference Woll M, Brisson P. Humanitarian care by a forward surgical team in Afghanistan. Mil Med. 2013;178(4):385–8.CrossRef Woll M, Brisson P. Humanitarian care by a forward surgical team in Afghanistan. Mil Med. 2013;178(4):385–8.CrossRef
17.
go back to reference Haddock G, Pollok AJ. Paediatric trauma in northern Iraq: the Kurdish refugee crisis. J R Coll Surg Edinb. 1992;37(4):221–4.PubMed Haddock G, Pollok AJ. Paediatric trauma in northern Iraq: the Kurdish refugee crisis. J R Coll Surg Edinb. 1992;37(4):221–4.PubMed
18.
go back to reference Trelles M, Dominguez L, Tayler-Smith K, Kisswani K, Zerboni A, Vandenborre T, et al. Providing surgery in a war-torn context: the Medecins Sans Frontieres experience in Syria. Confl Health. 2015;9:36.CrossRef Trelles M, Dominguez L, Tayler-Smith K, Kisswani K, Zerboni A, Vandenborre T, et al. Providing surgery in a war-torn context: the Medecins Sans Frontieres experience in Syria. Confl Health. 2015;9:36.CrossRef
19.
go back to reference Trudeau MO, Baron E, Herard P, Labar AS, Lassalle X, Teicher CL, et al. Surgical care of pediatric patients in the humanitarian setting: The Medecins Sans Frontieres Experience, 2012-2013. JAMA surgery. 2015;150(11):1080–5.CrossRef Trudeau MO, Baron E, Herard P, Labar AS, Lassalle X, Teicher CL, et al. Surgical care of pediatric patients in the humanitarian setting: The Medecins Sans Frontieres Experience, 2012-2013. JAMA surgery. 2015;150(11):1080–5.CrossRef
20.
go back to reference Er E, Corbacioglu SK, Guler S, Aslan S, Seviner M, Aksel G, et al. Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war. Am J Emerg Med. 2017;35(1):82–6.CrossRef Er E, Corbacioglu SK, Guler S, Aslan S, Seviner M, Aksel G, et al. Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war. Am J Emerg Med. 2017;35(1):82–6.CrossRef
21.
go back to reference Coppola CP, Leininger BE, Rasmussen TE, Smith DL. Children treated at an expeditionary military hospital in Iraq. Archives of pediatrics & adolescent medicine. 2006;160(9):972–6.CrossRef Coppola CP, Leininger BE, Rasmussen TE, Smith DL. Children treated at an expeditionary military hospital in Iraq. Archives of pediatrics & adolescent medicine. 2006;160(9):972–6.CrossRef
22.
go back to reference Matos RI, Holcomb JB, Callahan C, Spinella PC. Increased mortality rates of young children with traumatic injuries at a US army combat support hospital in Baghdad, Iraq, 2004. Pediatrics. 2008;122(5):e959–66.CrossRef Matos RI, Holcomb JB, Callahan C, Spinella PC. Increased mortality rates of young children with traumatic injuries at a US army combat support hospital in Baghdad, Iraq, 2004. Pediatrics. 2008;122(5):e959–66.CrossRef
23.
go back to reference Edwards MJ, Lustik M, Burnett MW, Eichelberger M. Pediatric inpatient humanitarian care in combat: Iraq and Afghanistan 2002 to 2012. J Am Coll Surg. 2014;218(5):1018–23.CrossRef Edwards MJ, Lustik M, Burnett MW, Eichelberger M. Pediatric inpatient humanitarian care in combat: Iraq and Afghanistan 2002 to 2012. J Am Coll Surg. 2014;218(5):1018–23.CrossRef
24.
go back to reference Creamer KM, Edwards MJ, Shields CH, Thompson MW, Yu CE, Adelman W. Pediatric wartime admissions to US military combat support hospitals in Afghanistan and Iraq: learning from the first 2,000 admissions. J Trauma. 2009;67(4):762–8.CrossRef Creamer KM, Edwards MJ, Shields CH, Thompson MW, Yu CE, Adelman W. Pediatric wartime admissions to US military combat support hospitals in Afghanistan and Iraq: learning from the first 2,000 admissions. J Trauma. 2009;67(4):762–8.CrossRef
25.
go back to reference Hoencamp R, Idenburg F, Vermetten E, Leenen L, Hamming J. Lessons learned from Dutch deployed surgeons and anesthesiologists to Afghanistan: 2006-2010. Mil Med. 2014;179(7):711–6.CrossRef Hoencamp R, Idenburg F, Vermetten E, Leenen L, Hamming J. Lessons learned from Dutch deployed surgeons and anesthesiologists to Afghanistan: 2006-2010. Mil Med. 2014;179(7):711–6.CrossRef
26.
go back to reference Kearney SP, Bluman EM, Lonergan KT, Arrington ED, Ficke JR. Preparedness of orthopaedic surgeons for modern battlefield surgery. Mil Med. 2012;177(9):1058–64.CrossRef Kearney SP, Bluman EM, Lonergan KT, Arrington ED, Ficke JR. Preparedness of orthopaedic surgeons for modern battlefield surgery. Mil Med. 2012;177(9):1058–64.CrossRef
27.
go back to reference Finnegan A, Finnegan S, Bates D, Ritsperis D, McCourt K, Thomas M. Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan study. Nurse Educ Today. 2015;35(1):104–12.CrossRef Finnegan A, Finnegan S, Bates D, Ritsperis D, McCourt K, Thomas M. Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan study. Nurse Educ Today. 2015;35(1):104–12.CrossRef
28.
go back to reference Haverkamp FJC, Veen H, Hoencamp R, Muhrbeck M, von Schreeb J, Wladis A, et al. Prepared for Mission? A survey of medical personnel training needs within the International Committee of the Red Cross. World J Surg. 2018. Haverkamp FJC, Veen H, Hoencamp R, Muhrbeck M, von Schreeb J, Wladis A, et al. Prepared for Mission? A survey of medical personnel training needs within the International Committee of the Red Cross. World J Surg. 2018.
29.
go back to reference Kirollos M, Anning C, Knag Fylkesnes G, Denselow J. The war on children. Save the Children International: London, United Kingdom; 2018. Kirollos M, Anning C, Knag Fylkesnes G, Denselow J. The war on children. Save the Children International: London, United Kingdom; 2018.
30.
go back to reference Hylden C, Johnson AE, Rivera JC. Comparison of female and male casualty cohorts from conflicts in Iraq and Afghanistan. US Army Med Dep J. 2015:80–5. Hylden C, Johnson AE, Rivera JC. Comparison of female and male casualty cohorts from conflicts in Iraq and Afghanistan. US Army Med Dep J. 2015:80–5.
31.
go back to reference Woods KL, Russell RJ, Bree S, Mahoney PF, McNicholas J. The pattern of paediatric trauma on operations. J R Army Med Corps. 2012;158(1):34–7.CrossRef Woods KL, Russell RJ, Bree S, Mahoney PF, McNicholas J. The pattern of paediatric trauma on operations. J R Army Med Corps. 2012;158(1):34–7.CrossRef
32.
go back to reference McKechnie PS, Wertin T, Parker P, Eckert M. Pediatric surgery skill sets in Role 3: the Afghanistan experience. Mil Med. 2014;179(7):762–5.CrossRef McKechnie PS, Wertin T, Parker P, Eckert M. Pediatric surgery skill sets in Role 3: the Afghanistan experience. Mil Med. 2014;179(7):762–5.CrossRef
33.
go back to reference Coupland RM, Samnegaard HO. Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals. BMJ. 1999;319(7207):410–2.CrossRef Coupland RM, Samnegaard HO. Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals. BMJ. 1999;319(7207):410–2.CrossRef
36.
go back to reference Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2006;41(1):92-8; discussion -8.CrossRef Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2006;41(1):92-8; discussion -8.CrossRef
37.
go back to reference Beckett A, Pelletier P, Mamczak C, Benfield R, Elster E. Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices. Injury. 2012;43(12):2072–7.CrossRef Beckett A, Pelletier P, Mamczak C, Benfield R, Elster E. Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices. Injury. 2012;43(12):2072–7.CrossRef
38.
go back to reference Edwards MJ, Lustik M, Carlson T, Tabak B, Farmer D, Edwards K, et al. Surgical interventions for pediatric blast injury: an analysis from Afghanistan and Iraq 2002 to 2010. J Trauma Acute Care Surg. 2014;76(3):854–8.CrossRef Edwards MJ, Lustik M, Carlson T, Tabak B, Farmer D, Edwards K, et al. Surgical interventions for pediatric blast injury: an analysis from Afghanistan and Iraq 2002 to 2010. J Trauma Acute Care Surg. 2014;76(3):854–8.CrossRef
39.
go back to reference Lansford T. Afghanistan at War: From the 18th-Century Durrani Dynasty to the 21st Century. California: ABC-CLIO; 2017. p. 4–6. Lansford T. Afghanistan at War: From the 18th-Century Durrani Dynasty to the 21st Century. California: ABC-CLIO; 2017. p. 4–6.
Metadata
Title
Global surgery for paediatric casualties in armed conflict
Authors
Frederike J. C. Haverkamp
Lisanne van Gennip
Måns Muhrbeck
Harald Veen
Andreas Wladis
Edward C. T. H. Tan
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-019-0275-9

Other articles of this Issue 1/2019

World Journal of Emergency Surgery 1/2019 Go to the issue