Pediatric Thoracic Trauma Mortality in Iraq and Afghanistan Compared to the United States National Trauma Data Bank

Authors

Ryan J. Keneally, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC 20052, USA.
Brittney A. Meyers, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC 20052, USA.
Cynthia H. Shields, Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Robert Ricca, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Kevin M. Creamer, Department of Pediatrics, The George Washington University, Washington, DC 20052, USA.

Document Type

Journal Article

Publication Date

3-28-2022

Journal

Military medicine

Volume

187

Issue

3-4

DOI

10.1093/milmed/usab020

Abstract

INTRODUCTION: The authors compared pediatric thoracic patients in the Joint Theatre Trauma Registry (JTTR) to those in the National Trauma Data Bank (NTDB) to assess differences in patient mortality rates and mortality risk accounting for age, injury patterns, and injury severity. MATERIALS AND METHODS: Patients less than 19 years of age with thoracic trauma were identified in both the JTTR and NTDB. Multiple logistic regression, χ2, Student's t-test, or Mann-Whitney U test were used as indicated to compare the two groups. RESULTS: Pediatric thoracic trauma patients seen in Iraq and Afghanistan (n = 955) had a significantly higher mortality rate (15.1 vs. 6.0%, P <.01) than those in the NTDB (n = 9085). After controlling for covariates between the JTTR and the NTDB, there was no difference in mortality (odds ratio for mortality for U.S. patients was 0.74, 95% CI 0.52-1.06, P = .10). The patients seen in Iraq or Afghanistan were significantly younger (8 years old, interquartile ratio (IQR) 2-13 vs. 15, IQR 10-17, P <.01) had greater severity of injuries (injury severity score 17, IQR 12-26 vs. 12, IQR 8-22, P <.01), had significantly more head injuries (29 vs. 14%, P <.01), and over half were exposed to a blast. DISCUSSION: Pediatric patients with thoracic trauma in Iraq and Afghanistan in the JTTR had similar mortality rates compared to the civilian population in the NTDB after accounting for confounding covariates. These findings indicate that deployed military medical professionals are providing comparable quality of care in extremely challenging circumstances. This information has important implications for military preparedness, medical training, and casualty care.

APA Citation

Keneally, Ryan J.; Meyers, Brittney A.; Shields, Cynthia H.; Ricca, Robert; and Creamer, Kevin M., "Pediatric Thoracic Trauma Mortality in Iraq and Afghanistan Compared to the United States National Trauma Data Bank" (2022). GW Authored Works. Paper 533.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/533

Department

Anesthesiology and Critical Care Medicine