1. Department of Defense Trauma Registry (DODTR) Description
A Review of the Pediatric Emergency Resuscitative Thoracotomies during Combat Operations in Iraq and Afghanistan
Guyon J. Hill, MD, Pediatric Emergency Medicine Fellow, PGY5+; Michael April, MD; Richard Connor, MD; John Oh, MD; Steven Schauer, DO*
+The University of Texas at Austin/Dell Children’s Medical Center Pediatric Emergency Medicine Fellowship,
* U.S. Army Institute of Surgical Research
Introduction
Results
The non-traditional nature of combat operations in Iraq and Afghanistan during the recent conflicts has led to a significant number of civilian casualties. Pediatric patients present unique challenges due to differences in size and physiology compared to adult combatants. There is a relative lack of data on emergency care for the pediatric trauma patient in the resource-limited conflict setting. There also remains little data on pediatric resuscitative thoracotomy overall with an absence of consensus for performing this procedure in the pediatric population.
We sought to describe survival following resuscitative thoracotomies in the pediatric population performed by US and coalition medical forces during combat operations in Iraq and Afghanistan.
During the study period, there were a total of 3,439 pediatric trauma admissions to definitive medical facilities, which accounted for 8.0% of total admissions. We identified 13 thoracotomy procedures (8 in the ED, 5 pre-Role III/pre-hospital) during the study period (see Table 1). In this cohort, the average age was 9.3 years (range 0-15 years). Most were male (N=10, 76.9%). The average composite ISS score was 23.2 (range 1-75). Out of the 13, 4 patients (2 MVC, 2 blast injuries) survived to hospital discharge.
Table 1
Design/Methods
Conclusions
In this cohort, 4 patients (2 MVC, 2 blast injuries) out of the 13 individuals that had an ED or prehospital resuscitative thoracotomy performed survived to hospital discharge. The youngest survivor of penetrating trauma (explosive, shrapnel) was less than 1 year of age and the youngest survivor of blunt MVC trauma was a 5-year-old. To the best of our knowledge, these are both younger than any previously reported pediatric thoracotomy survivors for these mechanisms. All of the survivors received the procedure in non-fixed facilities, potentially demonstrating the benefits of forward staging surgical assets in resource-limited or conflict settings. The utility of this resuscitative procedure in the pediatric population remains poorly defined with accumulation of larger data sets still necessary.
We queried the Department of Defense Trauma Registry (DODTR) from 2007 to 2016 for all pediatric patients (defined as younger than 15 years to exclude potential combatants) that underwent a resuscitative thoracotomy. We excluded subjects if the procedure did not have a documented location or occurred after leaving the ED (i.e. in the operating room).
Department of Defense Trauma Registry (DODTR) Description
Acknowledgements
The DODTR, formerly known as the Joint Theater Trauma Registry (JTTR) is the data repository for DOD trauma-related injuries. The DODTR includes documentation regarding demographics, injury-producing incidents, diagnoses, treatments, and outcomes of injuries sustained by US/non-US military and US/non-US civilian personnel in wartime and peacetime from the point of injury to final disposition. We combined DODTR data on prehospital intervention efficacy from the fixed-facility with information within AARs (After-Action Reviews) in determining whether hemorrhage control was successful or not.
We would like to thank the Joint Trauma System Data Analysis Branch, Joint Trauma System, US Army Institute for Surgical Research for their efforts with data acquisition.
Disclaimer
Opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense.
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