DISASTER MEDICINE No. 4•2023

https://doi.org/10.33266/2070-1004-2023-4

Review article

Medical Care for Children Affected by Armed Conflict: a Systematic Literature Review

Zorin V.I. 1,2, Rybinskikh T.S. 1

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1 H.Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, St. Petersburg, Russian Federation

2 Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation

UDC 614.812+616-082

Pp. 33-41

Summary. The aim of the study is to analyze the data on mortality, structure of injuries, terms of hospitalization, routing of patients and organization of medical care for children injured in armed conflicts and terrorist acts.

Materials and research methods. A systematic review was performed in accordance with the recommendations of the PRISMA protocol. A comprehensive search was conducted in PubMed, ScienceDirect, E-library, and GoogleScholar databases for the period from 1995 to 2022. The search revealed 2995 publications, of which 25 papers were included in the quantitative analysis according to the inclusion criteria.

Results of the study and their analysis. We analyzed 54205 cases of medical care for children injured in 15 armed conflicts and 48 terrorist attacks between 1988 and 2020. The average age of the injured children was 9.7 years; the proportion of children in the total mass of the injured was 12.7%. The average percentage of bed days in children was 10.9%; the average duration of hospitalization was 7.4 days; 82% of patients required surgery; the pediatric mortality rate was 7.6%. The most common mechanisms of injury in children were shrapnel and explosive wounds; the most frequent cause of death was craniocerebral trauma.

Keywords: armed conflicts, gunshot wounds, hospitalization, injured children, medical care, mortality, routing, structure of injuries, trauma

Conflict of interest. The authors declare no conflict of interest

For citation: Zorin V.I., Rybinskikh T.S. Medical Care for Children Affected by Armed Conflict: a Systematic Literature Review. Meditsina Katastrof = Disaster Medicine. 2023;4:33-41 (In Russ.). https://doi.org/10.33266/2070-1004-2023-4-33-41

 

СПИСОК ИСТОЧНИКОВ / REFERENCES

  1. Davies S, Pettersson T, Öberg M. Organized Violence 1989–2021 and Drone Warfare. J Peace Res. 2022;59(4):593–610.
  2. Гончаров С.Ф., Петлах В.И., Розинов В.М. Медицинская помощь детям, пострадавшим в локальных военных конфликтах и террористических актах // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2015;5(1):21-26. [Goncharov S.F., Petlakh V.I., Rozinov V.M. Medical Care for children Damage in Local Military Conflicts and terrorist attacks. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2015;5(1):21-26 (In Russ.)]. URL: https://cyberleninka.ru/article/n/meditsinskaya-pomosch-detyam-potradavshim-v-lokalnyh-voennyh-konfliktah-i-terroristicheskih-aktah (accessed date: 02.05.2023).
  3. Adamkiewicz T, Goldhagen J. Mitigating Armed Conflict Casualties in Children. Pediatrics. 2020;146(6).
  4. Khorram-Manesh A, Burkle FM, Goniewicz K, Robinson Y. Estimating the Number of Civilian Casualties in Modern Armed Conflicts-a Systematic Review. Front Public Health. 2021;9:765261. URL: http://www.ncbi.nlm.nih.gov/pubmed/34778192 (accessed date: 11.11.2022).
  5. Khorram-Manesh A, Burkle FM. Civilian Population Victimization: a Systematic Review Comparing Humanitarian and Health Outcomes in Conventional and Hybrid Warfare. Disaster Med Public Health Prep. 2022.
  6. Haverkamp FJC, Van Gennip L, Muhrbeck M, Veen H, Wladis A, Tan ECTH. Global Surgery for Pediatric Casualties in Armed Conflict. World Journal of Emergency Surger]. 2019;14(1):1–8. URL: https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0275-9 (accessed date: 26.12.2022).
  7. Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. Pediatric Casualties in Contemporary Armed Conflict: a Systematic Review to Inform Standardized Reporting. Injury. 2021;52(7):1748–56.
  8. Bitterman Y, Benov A, Glassberg E, Satanovsky A, Bader T, Sagi R. Role 1 Pediatric Trauma Care on the Israeli-Syrian Border-First Year of the Humanitarian Effort. Mil Med. 2016;181(8):849–53. URL: https://pubmed.ncbi.nlm.nih.gov/27483523/ (accessed date: 02.05.2023).
  9. Samuel N, Hirschhorn G, Chen J, Steiner IP, Shavit I. Prehospital Injury Severity of Children Evacuated by Helicopters from Combat Zones: a Retrospective Report. Journal of Emergency Medicine. 2013;44(3):641–5.
  10. Pannell D, Poynter J, Wales PW, Tien H, Nathens AB, Shellington D. Factors Affecting Mortality of Pediatric Trauma Patients Encountered in Kandahar, Afghanistan. Can J Surg. 2015;58(3 Suppl 3):S141–5. URL: https://pubmed.ncbi.nlm.nih.gov/26100774/ (accessed date: 25.12.2022).
  11. Reyna TM. Observations of a Pediatric Surgeon in the Persian Gulf War. J Pediatr Surg. 1993;28(2):209–13.
  12. Health IGBM, 2004 undefined. Pediatric Casualties during OP TELIC. URL: https://militaryhealth.bmj.com/content/150/4/270.short?casa_token=PTyIJ0sw-UAAAAAA:xYBiNNsbvo2AoGeBk6qUg5saVuajL6WBW3ax5LY_tu39WKr7kkEe8rgzeZLBxO8EzlqZExZ0J6D-HdFW (accessed date: 11.11.2022).
  13. Burnett MW, Spinella PC, Azarow KS, Callahan CW. Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004. Pediatrics. 2008;121(2):261–5. URL: https://pubmed.ncbi.nlm.nih.gov/18245416/ (accessed date: 25.12.2022).
  14. McGuigan R, Spinella PC, Beekley A, Sebesta J, Perkins J, Grathwohl K, et al. Pediatric Trauma: Experience of a Combat Support Hospital in Iraq. J Pediatr Surg. 2007;42(1):207–10.
  15. Creamer KM, Edwards MJ, Shields CH, Thompson MW, Yu CE, Adelman W. Pediatric Wartime Admissions to US Military Combat Support Hospitals in Afghanistan and Iraq: Learning from the first 2,000 Admissions. J Trauma. 2009;67(4):762–8. URL: https://pubmed.ncbi.nlm.nih.gov/19820583/ (accessed date: 25.12.2022).
  16. Borgman M, Matos RI, Blackbourne LH, Spinella PC. Ten Years of Military Pediatric Care in Afghanistan and Iraq. J Trauma Acute Care Surg. 2012;73(6 Suppl 5). URL: https://pubmed.ncbi.nlm.nih.gov/23192078/ (accessed date: 25.12.2022).
  17. Coppola CP, Leininger BE, Rasmussen TE, Smith DL. Children Treated at an Expeditionary Military Hospital in Iraq. Arch Pediatr Adolesc Med. 2006;160(9):972–6. URL: https://pubmed.ncbi.nlm.nih.gov/16953022/ (accessed date: 02.05.2023).
  18. Matos RI, Holcomb JB, Callahan C, Spinella PC. Increased Mortality Rates of Young Children with Traumatic Injuries at a US Army Combat Support Hospital in Baghdad, Iraq, 2004. Pediatrics. 2008;122(5). URL: https://pubmed.ncbi.nlm.nih.gov/18977963/ (accessed date: 02.05.2023).
  19. Arul GS, Reynolds J, DiRusso S, Scott A, Bree S, Templeton P, Midwinter M J. Pediatric Admissions to the British Military Hospital at Camp Bastion, Afghanistan. Ann R Coll Surg Engl. 2012;94(1):e52–4. URL: https://pubmed.ncbi.nlm.nih.gov/22524930/ (accessed date: 02.05.2023).
  20. Розинов В.М., Петлах В.И., Иванов Д.Ю., Шабанов В.Э. Опыт Беслана: эффективность лечебно-эвакуационного обеспечения детей // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2015;5(1):33-41 [Rozinov V.M., Petlakh V.I., Ivanov D.Yu., Shabanov V.E. Experience of Beslan: the Effeciency Of Medical Evacuation Support of Children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2015;5(1):33-41 (In Russ.)]. URL: https://cyberleninka.ru/article/n/opyt-beslana-effektivnost-lechebno-evakuatsionnogo-obespecheniya-detey (accessed date: 02.05.2023).
  21. Children War Casualties during the 1991-1995 Wars in Croatia and Bosnia and Herzegovina – PubMed. URL: https://pubmed.ncbi.nlm.nih.gov/11259737/ (accessed date: 25.12.2022).
  22. Naaman O, Yulevich A, Sweed Y. Syria Civil War Pediatric Casualties Treated at a Single Medical Center. J Pediatr Surg. 2020;55(3):523–9.
  23. Waisman Y, Aharonson-Daniel L, Mor M, Amir L, Peleg K. The Impact of Terrorism on Children: a Two-Year Experience. Prehosp Disaster Med. 2003;18(3):242–8. URL: https://pubmed.ncbi.nlm.nih.gov/15141864/ (accessed date: 02.05.2023).
  24. Er E, Çorbacıoğlu ŞK, Güler S, Aslan Ş, Seviner M, Aksel G, et al. Analyses of Demographical and Injury Characteristics of Adult and Pediatric Patients Injured in Syrian Civil War. Am J Emerg Med. 2017;35(1):82–6. URL: https://pubmed.ncbi.nlm.nih.gov/27771222/ (accessed date: 02.05.2023).
  25. Amir LD, Aharonson-Daniel L, Peleg K, Waisman Y, Alfici R, Ishtov E, et al. The Severity of Injury in Children Resulting from Acts against Civilian Populations. Ann Surg. 2005;241(4):666–70. URL: https://pubmed.ncbi.nlm.nih.gov/15798470/ (accessed date: 02.05.2023).
  26. Çelikkaya ME, Atlcl A, El Ç, Akçora B. Innocent Children in the Syrian Civil War. Eur J Pediatr Surg. 2020;30(2):215–9. URL: https://pubmed.ncbi.nlm.nih.gov/31739348/ (accessed date: 02.05.2023).
  27. Guha-Sapir D, Schlüter B, … JRLTLG, 2018 undefined. Patterns of Civilian and Child Deaths Due to War-Related Violence in Syria: a Comparative Analysis from the Violation Documentation Center Dataset, 2011–16. Elsevier. 2018. URL: https://www.sciencedirect.com/science/article/pii/S2214109X17304692 (accessed date: 11.11.2022).
  28. Carlson LC, Lafta R, Al-Shatari S, Stewart BT, Burnham G, Kushner AL. Pediatric Injury During Conflict and Prolonged Insecurity in Iraq from 2003-2014. Surgery. 2016;160(2):493–500. URL: https://pubmed.ncbi.nlm.nih.gov/27155907/ (accessed date: 02.05.2023).
  29. Çelikel A, Karbeyaz K, Kararslan B, Arslan MM, Zeren C. Childhood Casualties during Civil War: Syrian Experience. J Forensic Leg Med. 2015;34:1–4. URL: https://pubmed.ncbi.nlm.nih.gov/26165650/ (accessed date: 02.05.2023).
  30. Bhutta ZA, Yousafzai AK, Zipursky A. Pediatrics, War and Children. Curr Probl Pediatr Adolesc Health Care. 2010;40(2):20–35.
  31. Er E, Çorbacıoğlu ŞK, Güler S, Aslan Ş, Seviner M, Aksel G, et al. Analyses of Demographical and Injury Characteristics of Adult and Pediatric Patients Injured in Syrian Civil War. Am J Emerg Med. 2017;35(1):82–6.

 

The material was received 18.07.23; the article after peer review procedure 03.11.23; the Editorial Board accepted the article for publication 22.12.23