War's youngest victims: a descriptive cross-sectional study on injury distributions, severity patterns, and outcomes among paediatric trauma patients in Kharkiv, Ukraine.

Background: Paediatric trauma in conflict zones is a major public health concern, with children being highly susceptible to both immediate injuries and long-term disabilities. The Russian Invasion of Ukraine in February 2022 has significantly affected the civilian population, particularly children. However, despite reports highlighting the extent of paediatric casualties, empirical data on injury patterns among children in the ongoing conflict remains scarce.

Objective: Describe the injury distributions, severity and outcomes of paediatric war-related trauma patients during the Russian invasion of Ukraine, using a hospital-based cohort from Kharkiv.

Methods: This descriptive cross-sectional study examined 64 war-related paediatric trauma patients (0-17 years) admitted to two Kharkiv hospitals between February 2022 and November 2023. Injury mechanisms, severity (using Abbreviated Injury Scale and Injury Severity Score [ISS]), and clinical outcomes were assessed.

Results: War-related injuries, including blast and shelling, accounted for 26% of all cases. Temporal analysis showed two peaks in injury incidence correlating with significant military events in the region. Analysis of the war-related injuries indicated that the most affected body regions included the upper extremities (31%), lower extremities (28%), and thorax (28%). The median ISS was 9, with over one-third (36%) of patients sustaining severe or critical injuries. Outcomes at discharge revealed a majority, 52%, achieved good recovery, followed by 41% with moderate disabilities. A smaller percentage (3%) faced severe disabilities, while 5% of the cases resulted in fatalities.

Conclusions: This study offers new insights into paediatric trauma from modern warfare in a high-income setting, highlighting the occurrence of blast and shelling injuries, injury patterns overall similar to previous conflicts, and high disability rates at discharge. The findings underscore the need for comprehensive trauma care, including acute treatment and long-term rehabilitation, and can inform improvements in care protocols, resource allocation, and rehabilitation strategies.