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The pattern of paediatric blast injury in Afghanistan
  1. Daniel C Thompson1,2,
  2. R J Crooks3,
  3. J C Clasper4,5,
  4. A Lupu6,
  5. S A Stapley1,7 and
  6. D J Cloke3
  1. 1 Defence Medical Group South, Queen Alexandra Hospital, Portsmouth, UK
  2. 2 Army Medical Service, Royal Military Academy Sandhurst, UK
  3. 3 201 (Northern) Field Hospital, Newcastle upon Tyne, UK
  4. 4 The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK
  5. 5 Defence Medical Group South East, Frimley Park Hospital, UK
  6. 6 SpR Trauma and Orthopaedics, Northern Deanery, UK
  7. 7 Royal Centre for Defence Medicine, Queen Elizabeth Hospital, BIrmingham, UK
  1. Correspondence to Dr Daniel C ThompsonArmy Medical Services and Queen Alexandra Hospital, Portsmouth PO6 3LY, UK; dcthompson101{at}


Introduction Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults.

Method A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2–15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region.

Results During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%).

Conclusion Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults.

  • blast
  • paediatrics
  • Afghanistan
  • IED
  • trauma
  • orthopedics

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  • Contributors All authors have made substantial contributions to the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be submitted.

  • Competing interests None declared.

  • Ethics approval This study was registered and approved by the Royal Centre for Defence Medicine Research Directorate (RCDM/Res/Audit/1036/12/0170) and has been granted permission to seek publication. Ethical approval was not sought as the paper uses retrospective analysis of anonymous patient data.

  • Provenance and peer review Not commissioned; externally peer reviewed.