Analysis Shows Gaps Remain in Wartime Pediatric Medical Care Readiness

A 20-year analysis of pediatric wartime medical care found that head injury, hemorrhaging, and burns were leading causes of death among children treated in deployed U.S. military medical facilities. The study, “Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022,” published in the April 2026 Pediatrics (published online March 10), reviewed 5,695 children treated for conflict-related injuries between 2001 and 2022. Most patients were treated at Role 3 facilities, which function similarly to civilian Level II trauma centers within the combat zone. Overall mortality was 9.4%, with the highest death rates occurring in children under 2 years of age. Mortality peaked at approximately 10.7% during years of heavy conflict from 2016-2017. Explosives were the most common mechanism of injury (42.8%) and death (40.7%), followed by gunshot wounds (26.3% of injuries; 24% of deaths) and motor vehicle incidents (11% of injuries and deaths). More than 70% of children experienced polytrauma, in which multiple severe injuries impacted multiple areas of the body. Younger children were more likely to sustain head injuries, while older children had increasing rates of lower extremity trauma. Non-survivors had a significantly higher injury severity score, greater blood loss, and required blood transfusions more frequently. However, transfusion practices were unbalanced, with disproportionately higher red blood cell use compared to platelets and plasma. Massive transfusion was nearly three times more common in non-survivors. Burn injuries carried nearly double the mortality rate compared to other primary injury types. Despite advances in adult combat casualty care, pediatric death due to armed conflict in deployed settings remains high. The authors recommend expanded pediatric-specific trauma training, standardized equipment, military–civilian partnerships, improved protocols for early hemorrhage recognition, and balanced resuscitation to reduce preventable deaths in children.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.