An Analysis of Intracranial Hemorrhage in Wartime Pediatric Casualties

Camaren M. Cuenca, Emily E. Clarke, Bradley A. Dengler, Matthew A. Borgman, Steven G. Schauer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Children make up a significant cohort of patients treated at combat support hospitals. Where traumatic head injury, including intracranial hemorrhage (ICH), is well studied in military adults, such research is lacking regarding pediatric patients. We seek to describe the incidence and outcomes of ICH within this population. Methods: This is a secondary analysis of a previously published dataset from the Department of Defense Trauma Registry for all pediatric casualties in Iraq and Afghanistan from January 2007 to January 2016. Within our dataset, we searched for casualties with an ICH. Results: Of the 3439 pediatric encounters in our dataset, we identified 495 (14%) casualties that had at least 1 type of ICH. Most were between 5 and 12 years of age, male (74%), and injured by an explosive (42%). Of the casualties with ICHs, 82 had epidural (16.6%), 237 had subdural (47.9%), 153 had subarachnoid (30.9%), 157 had parenchymal bleeds (31.7%), and 239 had ICHs not otherwise specified (48.3%). In the hospital setting, the epidural group was more frequently treated with skull decompression (41%) and craniotomy with skull elevation (28%). The subdural group was more frequently treated with a craniectomy (17%) and the parenchymal group had more frequent intracranial pressure monitoring (18%). In our dataset, 22 received ketamine prehospital (4.4%) and most were discharged alive from the hospital (79%). Conclusions: Within our dataset, we identified 495 cases of ICH in pediatric patients. Most survived to hospital discharge despite less than half undergoing a decompression procedure.

Original languageEnglish (US)
Pages (from-to)e729-e733
JournalWorld neurosurgery
Volume154
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • Hemorrhage
  • Intracranial
  • Military
  • Pediatric
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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