Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022.

Abstract

OBJECTIVE Pediatric mortality from conflict-related injuries exceeds that of adults. Understanding pediatric injury patterns and outcomes is critical for guiding resource allocation and training. This study characterizes pediatric injuries in conflict zones and examines relationships between injury patterns, resource allocation, and survival. METHODS A retrospective cohort analysis of the Department of Defense Trauma Registry from 2001 to 2022 was conducted for children younger than 18 years treated at deployed military treatment facilities in conflict zones with documented injuries and discharge status. The primary outcome was survival to hospital discharge. RESULTS A total of 5695 children met inclusion criteria with an overall mortality rate of 9.4%. Nonsurvivors had higher injury severity scores (25 vs 9, P < .001), were younger, and sustained burn injuries (18.1% vs 9.4%, P < .001). They experienced greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, P < .001) and required more transfusions (47.9% vs 29.4% P < .001). Neither group received balanced transfusion, with packed red blood cell-to-platelet ratios of 4:1 in nonsurvivors and 6.5:1 in survivors. CONCLUSION This large epidemiologic study highlights age-specific injury patterns and resuscitation needs contributing to pediatric mortality in conflict zones. Higher blood loss and resuscitation volumes in nonsurvivors underscore the need for early hemorrhage control. Findings support strategies that include standardized pediatric equipment and targeted training in early recognition and management of hemorrhagic shock with balanced transfusion. These results emphasize the need for tailored resources and protocols for pediatric patients in austere, conflict-related settings.