Pediatric Trauma Patient Intensive Care Resource Utilization in U.S. Military Operations in Iraq and Afghanistan

Abstract

Objectives: Children represent a unique patient population treated by military personnel during wartime, as seen in the recent conflicts in Iraq and Afghanistan. We sought to describe ICU resource utilization by U.S. military personnel treating pediatric trauma patients in Iraq and Afghanistan. Design: This is a retrospective review of prospectively collected data within Department of Defense Trauma Registry. Setting: We studied pediatric casualties treated in U.S. and coalition military hospitals in Iraq and Afghanistan between January 2007 and January 2016. Patients: We queried the Department of Defense Trauma Registry for patients less than 18 years with one documented day within an ICU. Interventions: We used descriptive statistics to analyze injuries patterns and interventions. We defined prolonged length of stay as ICU stay four days or greater. Regression methodology was utilized to identify factors associated with prolonged length of stay. Measurements and Main Results: There were 1955 (56.8%) pediatric patients that met our inclusion criteria. The most common mechanism of injury was explosive (45.2%) followed by gunshot wounds (20.8%). The median composite ISS was 14. The median length of stay was 3 days with 90.2% surviving to hospital discharge. Mechanical ventilation was the most frequent intervention (67.6%) followed by arterial access (21.8%). Prolonged length of stay was associated with all serious injuries, ventilator management, blood product administration, wound dressing, bronchoscopy, imaging, and central venous access. Conclusions: Pediatric casualties accounted for nearly one in 10 admissions with the majority requiring intensive care. The most commonly performed interventions were mechanical ventilation, vascular access, and imaging, each of which requires a specialized skill set to provide optimal patient management. All serious injuries by body region except facial were associated with a prolonged length of ICU stay, as well as blood product administration, ventilator management, intracranial pressure monitoring, wound care, bronchoscopy, imaging, and central venous access. The epidemiology of this unique population may be useful in planning future pre-deployment training and resource management in ICUs in deployed environments.