Pediatric surgery skill sets in Role 3: the Afghanistan experience.

BACKGROUND: The Role 3 Hospital at Camp Bastion, Afghanistan, is regarded as one of the most capable trauma hospitals in the world. It has treated almost 7,000 trauma patients since 2006 and performed over 10,000 trauma operations. Pediatric patients form a significant proportion of this workload but pediatric specialists are not routinely deployed. The relevant surgery skill sets have not been specifically investigated.

METHODS: The Joint Theater Trauma Registry was retrospectively reviewed for all pediatric trauma cases admitted to the Role 3 Hospital at Camp Bastion, Afghanistan from July 2008 to November 2012. Patient demographics and surgical procedures were recorded.

RESULTS: During the study period, there were 766 pediatric patients admitted. A total of 3,390 surgical and resuscitative procedures were performed: 477 extremity injuries required 156 major amputations, 341 abdominal surgical procedures included 120 exploratory laparotomies, 329 thoracic procedures were performed including 4 tracheal repairs and 2 lung resections; and 177 vascular procedures were also performed.

CONCLUSIONS: The surgical caseload over this study period ascertains the pediatric skill sets that the deployed surgeon should possess. None of these procedures are specific to the pediatric population. This could help guide focused training although reassuring the deployed surgeon of the likely pediatric surgical presentations, and therefore their competence in dealing with them.