Children war casualties during the 1991-1995 wars in Croatia and Bosnia and Herzegovina

Aim. To analyze clinical course of war-related injuries in children treated at the Split University Hospital during the wars in Croatia (1991-1995) an d Bosnia and Herzegovina (1992-1995). Methods. Medical records of 94 treated children were analyzed. The severity of wounds was scored according to the Abbreviated Injury Scale (AIS) and I njury Severity Score (ISS) evaluation systems. Results. Most children were wounded during shelling/bombing (n=28, 10 boys and 18 girls) and by leftover explosive devices (n=26). Children injured by leftover explosive devices were predominantly boys (23/26 children), aged 10 to 16 years (19/26 children). Extremities were the most frequently wound ed body regions (43% of all wounded regions). The wounds to the head/neck ( median AIS=5.0, range 1-6) and abdomen (median AIS=4.5, range 3-5) were the most severe. Abdominal wounds required surgical procedures (p<0.001) and a ntibiotic treatment (p<0.05) most frequently, as well as patients with grea ter AIS and ISS scores (p<0.05). According to the treatment outcome, more p atients wounded to the abdomen and extremities showed improvement than no c hange or complete recovery (p<0.05). Permanent disability remained in 37 (3 9.4%) children and three (3.3%) children died. Conclusion. Boys in upper elementary grades and high school were at greater risk of being wounded by fragments of leftover explosive devices than youn ger boys or girls. The most severe wounds were to the head/neck and the abd omen and inflicted during the shelling or bombing. This should be taken int o account in organization of surgical care for the children with war-relate d injuries.