Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. e959-e966 (doi:10.1542/peds.2008-1244)

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ARTICLE

Increased Mortality Rates of Young Children With Traumatic Injuries at a US Army Combat Support Hospital in Baghdad, Iraq, 2004

Renée I. Matos, MD^a, John B. Holcomb, MD^b, Charles Callahan, DO^c and Philip C. Spinella, MD^b,d

^a Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, Texas
^b US Army Institute of Surgical Research, Brook Army Medical Center, San Antonio, Texas
^c Walter Reed Army Medical Center, Washington, DC
^d Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut

OBJECTIVE. The objective of this study was to determine whether age 8 y is an independent predictor of mortality in noncoalition trauma patients at a US combat support hospital.

METHODS. A retrospective chart review was conducted of 1132 noncoalition trauma patients who were admitted to a combat support hospital between December 2003 and December 2004. Data on age, severity of injury indices, and in-hospital mortality rates were analyzed. All variables that were associated with death on univariate analysis were analyzed by multivariate logistic regression to determine independent associations with mortality.

RESULTS. There were 38 young pediatric patients (aged 8 years) and 1094 older pediatric and adult patients (aged >8 years). Penetrating trauma accounted for 83% of all injuries. Young pediatric patients compared with older pediatric and adult patients had increased severity of injury indicated by decreased Glasgow Coma Scale score; increased incidence of hypotension, base deficit, and serum pH on admission; red blood cell transfusion amount; and increased injury severity scores on admission. Young pediatric patients compared with older pediatric and adult patients also had increased ICU lengths of stay (median 2 [interquartile range 0–5] vs median 0 [interquartile range 0–2] days) and in-hospital mortality rate (18% vs 4%), respectively. Multivariate logistic regression indicated that base deficit, injury severity score of 15, Glasgow Coma Scale score of 8, and age of 8 years were independently associated with mortality.

CONCLUSIONS. Young children who present to a combat support hospital have increased severity of injury compared with older children and adults. In a population with primarily penetrating injuries, after adjustment for severity of injury, young children may also have an independent increased risk for death compared with older children and adults. Providing forward-deployed medical staff with pediatric-specific equipment and training in the acute care of young children with severe traumatic injuries may improve outcomes in this population.

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Key Words: pediatric • trauma • mortality • survival • combat • penetrating

Abbreviations: CSH—combat support hospital • PALS—Pediatric Advanced Life Support • ISS—injury severity score • AIS—Abbreviated Injury Scale • IQR—interquartile range • GCS—Glasgow Coma Scale

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Accepted Jul 31, 2008.

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