Care of Pediatric Neurosurgical Patients in Iraq in 2007: Clinical and Ethical Experience of a Field Hospital

摘要

Object. Care for host-nation pediatric casualties and disease or nonbattle injuries is an essential mission of deployed military medical assets. Clinical experience with pediatric patients at field hospitals has been increasingly reported since 2001, with neurotrauma identified as a major cause of morbidity and death in this population. A concentrated pediatric neurosurgical experience at a deployed medical facility has not been reported. The authors reviewed their experience with pediatric neurosurgical patients at a field hospital in Iraq in 2007 to provide insight into the management of this patient population. Methods. A retrospective review was conducted using a prospective database constructed by the authors for quality improvement during a single combat rotation in 2007. Results. Forty-two patients among 287 consultations were 17 years of age or younger. Twenty-six of these children were 8 years old or younger. Penetrating head injuries were the most common indication for consultation (22 of 42 patients). Twenty-eight of 130 surgical procedures were performed in the children. One patient died in the perioperative period, for a trauma-related operative mortality rate of 4%. Seven patients received palliative care based on the extent of presenting injuries. Twenty-five patients were discharged with minimal or no neurological deficits. Conclusions. Pediatric patients represent a significant proportion of the neurosurgical patient volume at field medical hospitals in the Iraqi theater. The mature medical theater environment present in 2007 allowed for remarkable diagnostic evaluation and treatment of these patients. Penetrating and closed craniospinal injuries were the most common indication for consultation. Disease and nonbattle injuries were also encountered, with care provided when deemed appropriate. The deployed environment presents unique medical and ethical challenges to neurosurgeons serving in forward medical facilities.