Research Paper Title

THAM Administration to Paediatric Trauma Patients in a Combat Zone.

Background

Paediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through haemorrhage control and volume restoration. Alkalising agents, including tris(hydroxymethyl)aminomethane (THAM), are potential therapeutic adjuncts to treat significant acidosis. There is, however, limited published data on THAM administration in the paediatric trauma population. We compared demographics and outcomes among paediatric trauma patients in Afghanistan and Iraq receiving THAM versus those not receiving THAM.

Methods

The researchers queried the Department of Defense Trauma Registry for all of the paediatric patients admitted to US and Coalition fixed-facility hospitals in Afghanistan and Iraq from January 2007 to January 2016. They retrieved data on age, sex, location, mechanism of injury, Injury Severity Scores, ventilator days, days in the intensive care unit, days of total hospitalisation, and survival to hospital discharge. They excluded subjects if they were dead on arrival to the emergency department.

Results

From January 2007 to January 2016, there were 3,386 paediatric subjects that met their inclusion criteria. Of these, 15 received THAM. The youngest subject receiving THAM was a 2-month-old burn victim. Subjects receiving THAM were more likely to be injured by submersion or burn (P < 0.001), had higher composite Injury Severity Scores (17 vs 10; P < 0.001) and Abbreviated Injury Scores for the thorax and abdomen (P = 0.004 and P = 0.019, respectively), and longer ventilator days/intensive care unit stays/hospital lengths of stay (P < 0.001/P < 0.001/P = 0.013). In addition, subjects receiving THAM had a lower survival rate than subjects not receiving THAM (73.3% vs 91.7%; P = 0.011).

Conclusions

THAM was administered rarely to paediatric trauma casualties during the conflicts in Afghanistan and Iraq. Subjects receiving THAM were more critically injured than the baseline population.

Reference

Naylor, J.F., April, M.D., Hill, G.J., Kempski, K.M., Arana, A.A., Schauer, S.G. (2018) THAM Administration to Pediatric Trauma Patients in a Combat Zone. Southern Medical Journal. 111(8), pp.453-456. doi: 10.14423/SMJ.0000000000000843.