Wartime vascular injuries in the pediatric population of Iraq and Afghanistan: 2002–2011

Authors

Carole Y. Villamaria, 59 MDW Wilford Hall Ambulatory Surgical Center, United States Army Institute of Surgical Research,Follow
Jonathan Morrison, United States Army Institute of Surgical Research,Follow
Colleen M. Fitzpatrick, St. Louis UniversityFollow
Jeremy W. Cannon, San Antonio Military Medical Center, Uniformed Services University of the Health SciencesFollow
Todd E. Rasmussen, 59 MDW Wilford Hall Ambulatory Surgical Center, United States Army Institute of Surgical Research,Follow

Date of this Version

2014

Citation

Journal of Pediatric Surgery 49 (2014) 428–432

Comments

This article is a U.S. government work, and is not subject to copyright in the United States.

Abstract

Background: Contemporary war-related studies focus primarily on adults with few reporting the injuries sustained in local pediatric populations. The objective of this study is to characterize pediatric vascular trauma at US military hospitals in wartime Iraq and Afghanistan. Methods: Reviewof the Department of Defense Trauma Registry (DoDTR) (2002–2011) identified patients (1– 17 years old) treated at US military hospitals in Iraq and Afghanistan using ICD-9 and procedure codes for vascular injury. Results: US military hospitals treated 4402 pediatric patients between 2002 and 2011. One hundred fifty-five patients (3.5%) had a vascular injury. Mean age, gender, and injury severity score (ISS) were 11.1 ± 4.1 years, 79% male, and 34 ± 13.5, respectively. Vascular injuries were primarily from penetrating mechanisms (95.6%; 58.0% blast injury) to the extremity (65.9%), torso (25.4%), and neck (8.6%). Injuries were ligated (31%), reconstructed (63%), or observed (2%). Limb salvage rate was 95%. Mortality rate was 9%. Conclusions: This study is the first to report vascular trauma in a pediatric population at wartime. Vascular injuries involve a high percentage of extremity and torso wounding. Torso vascular injury in children is four times lethal relative to other injury patterns, and therefore should be considered in operational planning both in the military and civilian setting regarding pediatric vascular injuries.