• Jason F Naylor, Michael D April, Guyon J Hill, Kelley M Kempski, Allyson A Arana, and Steven G Schauer.
• From the Madigan Army Medical Center, Joint Base Lewis McChord, Washington, the San Antonio Military Medical Center and the US Army Institute of Surgical Research Joint Base San Antonio Fort Sam Houston, Texas, and the 59th Medical Wing, Joint Base San Antonio Lackland Air Force Base, Texas.
• South. Med. J. 2018 Aug 1; 111 (8): 453-456.

ObjectivesPediatric 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 hemorrhage control and volume restoration. Alkalizing 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 pediatric trauma population. We compared demographics and outcomes among pediatric trauma patients in Afghanistan and Iraq receiving THAM versus those not receiving THAM.MethodsWe queried the Department of Defense Trauma Registry for all of the pediatric patients admitted to US and Coalition fixed-facility hospitals in Afghanistan and Iraq from January 2007 to January 2016. We retrieved data on age, sex, location, mechanism of injury, Injury Severity Scores, ventilator days, days in the intensive care unit, days of total hospitalization, and survival to hospital discharge. We excluded subjects if they were dead on arrival to the emergency department.ResultsFrom January 2007 to January 2016, there were 3386 pediatric subjects that met our 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).ConclusionsTHAM was administered rarely to pediatric trauma casualties during the conflicts in Afghanistan and Iraq. Subjects receiving THAM were more critically injured than the baseline population.

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