Sargent Will, Mahoney P, Clasper J, Bull A, Reavley P, Gibb I
Centre for Blast Injury Studies, Imperial College London, London, UK
Centre for Blast Injury Studies, Imperial College London, London, UK.
BMJ Mil Health. 2024 Dec 11;170(e2):e116-e121. doi: 10.1136/military-2022-002336.
There is a need for quality medical care for children injured in conflict, but a description of injuries and injury burden from blast and ballistic mechanisms is lacking. The radiology records of children imaged during the war in Afghanistan represent a valuable source of information about the patterns of paediatric conflict injuries.
The UK military radiological database was searched for all paediatric presentations to Camp Bastion during 2011. Reports and original images were reviewed to determine location and severity of injuries sustained. Additional information was obtained from imaging request forms and the Joint Theatre Trauma Register, a database of those treated at UK medical facilities in Iraq and Afghanistan.
Radiology was available for 219 children. 71% underwent CT scanning. 46% suffered blast injury, 22% gunshot wounds (GSWs), and 32% disease and non-battle injuries (DNBIs). 3% had penetrating head injury, 11% penetrating abdominal trauma and 8% lower limb amputation, rates far exceeding those found in civilian practice. Compared with those with DNBI, those with blast or GSW were more likely to have serious (Abbreviated Injury Score, AIS, ≥3) injuries (median no. AIS ≥3 injuries were 1 for blast, 1 for GSW and 0 for DNBI, p<0.05) and children exposed to blast were more likely to have multiple body regions with serious injuries (OR for multiple AIS ≥3 injuries for blast vs DNBI=5.811 CI [1.877 to 17.993], p<0.05).
Paediatric conflict injuries are severe, and clinicians used only to civilian practice may be unprepared for the nature and severity of injuries inflicted on children in conflict. Whole-body CT for those with conflict-related injuries, especially blast, is hugely valuable. We recommend that CT is used for paediatric assessment in blast and ballistic incidents and that national imaging guidelines amend the threshold for doing so.
冲突中受伤儿童需要高质量的医疗护理，但目前缺乏关于爆炸和弹道机制造成的损伤及损伤负担的描述。阿富汗战争期间接受成像检查的儿童的放射学记录是有关儿童冲突性损伤模式的宝贵信息来源。
检索英国军方放射学数据库，查找2011年期间在巴斯蒂安营地就诊的所有儿科病例。审查报告和原始图像，以确定所受损伤的部位和严重程度。从成像申请表和联合战区创伤登记处获取了更多信息，联合战区创伤登记处是在伊拉克和阿富汗的英国医疗设施接受治疗的人员的数据库。
有219名儿童的放射学资料可供使用。71%的儿童接受了CT扫描。46%的儿童遭受爆炸伤，22%的儿童遭受枪伤，32%的儿童患有疾病和非战斗损伤（DNBI）。3%的儿童有穿透性头部损伤，11%的儿童有穿透性腹部创伤，8%的儿童下肢截肢，这些比率远远超过了在平民医疗实践中发现的比率。与患有DNBI的儿童相比，遭受爆炸伤或枪伤的儿童更有可能受到严重损伤（简明损伤评分，AIS，≥3）（爆炸伤的AIS≥3损伤中位数为1，枪伤为1，DNBI为0，p<0.05），并且遭受爆炸伤的儿童更有可能在多个身体部位受到严重损伤（爆炸伤与DNBI相比，多处AIS≥3损伤的比值比=5.811，置信区间[1.877至17.993]，p<0.05）。
儿童冲突性损伤很严重，仅熟悉平民医疗实践的临床医生可能对冲突中儿童所受损伤的性质和严重程度没有做好准备。对有冲突相关损伤的儿童，尤其是爆炸伤儿童进行全身CT检查非常有价值。我们建议在爆炸和弹道事件中对儿童进行CT评估，并建议国家成像指南修改这样做的阈值。
