Pediatric neurotrauma management: the Afghan experience

Abstract

The mainmechanism of injury in Afghanistan is the explosion of improvised explosive devices, associated with a high fatality rate and severe blast injuries. The head/neck area is particularly involved in children. Craniocerebral injuries account for more than 25% of the war wounds in children and are the first cause of death. The Kabul role 3 medical treatment facility was improved for children care with craniocerebal trauma. At reception of the MedEvac request, the emergency room is prepared to be ready and organized at arrival of the casualty. A head computerized tomography (CT)-scan is systematically realized, except in cases of life-threatening hemorrhage. Neurosurgical care of cerebral wounds focuses on the prevention of infection and increased intracranial pressure. Neurosurgery care of craniocerebral injuries is based on necrotic tissues debridement, dura mater repair and closure. Decompressive craniectomy is sometimes required. Neurointensive care is based on the prevention of systemic secondary brain insults, based on intracranial pressure monitoring. Infectious and seizure risks are also prevented. Significant ethical issues are considered in this country in war. Pediatric war neurotraumatology is a specific but daily activity in the intensive care unit at the Kabul role 3 medical treatment facility. In this article, the authors report the experience of the neurointensive care of Afghan children, who are unintended casualties of various devices explosion.