Increased mortality rates of young children with traumatic injuries at a US army combat support hospital in Baghdad, Iraq, 2004.

Pediatrics 122(5):e959-66 (2008) PMID 18977963

OBJECTIVE: The objective of this study was to determine whether age 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 >or=15, Glasgow Coma Scale score of <or=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.