{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T09:32:46Z","timestamp":1793871166921,"version":"4.6.1"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>Blast injuries are a major cause of morbidity and mortality in modern conflicts and terrorist incidents, placing children in particular danger in both combat and civilian settings. Pediatric blast trauma differs notably from adult presentations due to unique anatomical, physiological, and developmental factors. This review highlights the etiology, demographic distribution, and injury patterns in pediatric blast victims, emphasizing distinctions from adults and the implications for clinical management. Children are frequently injured in terrorism-related explosions, explosive remnants of war, and accidental incidents such as fireworks, with a consistent male predominance. Head injuries are more common and severe in children, reflecting larger head-to-body ratios, thinner skulls, and a lack of protective equipment. Ocular trauma, tympanic membrane rupture, and primary blast lung injury occur at higher rates than in adults. Abdominal trauma, though less frequent, contributes disproportionately to mortality due to thinner abdominal walls and larger solid organs. Extremity injuries are the most common overall, particularly upper limb amputations from unexploded ordnance and lower limb amputations from landmines. Burn and inhalation injuries, although less prevalent, are associated with markedly higher mortality in children compared to adults. Management poses unique challenges: pediatric airway anatomy predisposes to obstruction; permissive hypotension strategies used in adults are inappropriate; and surgical needs, including laparotomy and orthopedic interventions, are more frequent. Beyond the physical trauma, psychosocial consequences are profound and require early, age-appropriate support. Pediatric blast injuries, therefore, demand customized guidelines that address their distinctive injury patterns and management requirements, highlighting the need for pediatric-specific protocols in emergency medicine.<\/jats:p>","DOI":"10.4103\/tjem.tjem_381_25","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T09:00:11Z","timestamp":1775206811000},"page":"87-93","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Pediatric blast injuries: Distinguishing features and unique challenges"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4221-1963","authenticated-orcid":false,"given":"Charlie Joe","family":"Layoun","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9619-6092","authenticated-orcid":false,"given":"Eveline","family":"Hitti","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1731-9076","authenticated-orcid":false,"given":"Rachelle","family":"El Helou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"R5-20260414","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S0140-6736(09)60257-9","article-title":"Blast injuries","volume":"374","author":"Wolf","year":"2009","journal-title":"Lancet"},{"key":"R6-20260414","article-title":"Abdominal Blast Injuries","year":"2009"},{"key":"R7-20260414","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.mpsur.2015.07.004","article-title":"Treatment principles of blast injuries","volume":"33","author":"Beaven","year":"2015","journal-title":"Surgery (Oxford)"},{"key":"R8-20260414","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1017\/S1049023X22000747","article-title":"Pediatric blast trauma:A systematic review and meta-analysis of factors associated with mortality and description of injury profiles","volume":"37","author":"Tovar","year":"2022","journal-title":"Prehosp Disaster Med"},{"key":"R9-20260414","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40621-023-00446-5","article-title":"The epidemiology of firework-related injuries in the US, 2012-2022","volume":"10","author":"Winicki","year":"2023","journal-title":"Inj Epidemiol"},{"issue":"Suppl 2","key":"R10-20260414","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1093\/jbcr\/irad045.133","article-title":"536 Firework injuries in pediatric patients:A 15 year review","volume":"44","author":"Johnston","year":"2023","journal-title":"J Burn Care Res"},{"key":"R11-20260414","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s00068-025-02785-y","article-title":"Firework injuries around New Year's Eve \u2013Epidemiology, injury patterns and risk factors","volume":"51","author":"Wegmann","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"R12-20260414","doi-asserted-by":"crossref","first-page":"e000452","DOI":"10.1136\/bmjpo-2019-000452","article-title":"Blast injuries in children:A mixed-methods narrative review","volume":"3","author":"Milwood Hargrave","year":"2019","journal-title":"BMJ Paediatr Open"},{"key":"R13-20260414","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1017\/S1049023X00006300","article-title":"The lasting legacy of war:Epidemiology of injuries from landmines and unexploded ordnance in Afghanistan, 2002-2006","volume":"23","author":"Bilukha","year":"2008","journal-title":"Prehosp Disaster Med"},{"key":"R14-20260414","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1007\/s00268-009-9978-5","article-title":"Effects of land mines and unexploded ordnance on the pediatric population and comparison with adults in rural Cambodia","volume":"33","author":"Bendinelli","year":"2009","journal-title":"World J Surg"},{"key":"R15-20260414","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1017\/S1049023X15005105","article-title":"Epidemiological study of child casualties of landmines and unexploded ordnances:A national study from Iran","volume":"30","author":"Mousavi","year":"2015","journal-title":"Prehosp Disaster Med"},{"key":"R16-20260414","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.jflm.2009.07.017","article-title":"Landmine associated injuries in children in Turkey","volume":"16","author":"Can","year":"2009","journal-title":"J Forensic Leg Med"},{"key":"R17-20260414","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1136\/jramc-2017-000795","article-title":"The pattern of paediatric blast injury in Afghanistan","volume":"166","author":"Thompson","year":"2020","journal-title":"BMJ Mil Health"},{"key":"R18-20260414","doi-asserted-by":"crossref","first-page":"26","DOI":"10.16899\/jcm.1604661","article-title":"Do accompanying traumas affect mortality in cases of blast-induced head trauma?","volume":"15","author":"Kaya","year":"2025","journal-title":"J Contemp Med"},{"key":"R19-20260414","first-page":"33","article-title":"Injury pattern of paediatric war casualties in the Syrian civil war:A systematic review","volume":"6","author":"Jhala","year":"2024","journal-title":"J High Threat Austere Med"},{"key":"R22-20260414","article-title":"Blast Injuries:Essential Facts","year":"2009"},{"key":"R23-20260414","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1631\/jzus.B1700051","article-title":"Blast-induced hearing loss","volume":"20","author":"Mizutari","year":"2019","journal-title":"J Zhejiang Univ Sci B"},{"key":"R24-20260414","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2352-4642(18)30073-7","article-title":"Paediatric blast injury:Challenges and priorities","volume":"2","author":"Bull","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"key":"R25-20260414","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1542\/peds.2007-2333","article-title":"Year 2007 position statement:Principles and guidelines for early hearing detection and intervention programs","volume":"120","year":"2007","journal-title":"Pediatrics"},{"key":"R26-20260414","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ijom.2010.07.005","article-title":"Patterns of maxillofacial injuries caused by terrorist attacks in Iraq:Retrospective study","volume":"40","author":"Gataa","year":"2011","journal-title":"Int J Oral Maxillofac Surg"},{"key":"R28-20260414","first-page":"156","article-title":"Children war casualties during the 1991-1995 wars in Croatia and Bosnia and Herzegovina","volume":"42","author":"Terzi\u0107","year":"2001","journal-title":"Croat Med J"},{"key":"R29-20260414","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.injury.2017.02.005","article-title":"Penetrating abdominal injuries during the Syrian war:Patterns and factors affecting mortality rates","volume":"48","author":"Arafat","year":"2017","journal-title":"Injury"},{"key":"R32-20260414","doi-asserted-by":"crossref","first-page":"233","DOI":"10.26719\/2025.31.4.233","article-title":"Challenges of children amputees in Gaza","volume":"31","author":"Al Shami","year":"2025","journal-title":"East Mediterr Health J"},{"key":"R33-20260414","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0022-3468(97)90199-8","article-title":"The spectrum of pediatric injuries after a bomb blast","volume":"32","author":"Quintana","year":"1997","journal-title":"J Pediatr Surg"},{"key":"R35-20260414","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1542\/pir.2016-0114","article-title":"Compartment syndrome in the pediatric patient","volume":"38","author":"Gresh","year":"2017","journal-title":"Pediatr Rev"},{"key":"R36-20260414","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/01241398-200109000-00025","article-title":"Acute compartment syndrome in children:Contemporary diagnosis, treatment, and outcome","volume":"21","author":"Bae","year":"2001","journal-title":"J Pediatr Orthop"},{"key":"R38-20260414","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.bjae.2019.12.002","article-title":"Update on the management of burns in paediatrics","volume":"20","author":"Suman","year":"2020","journal-title":"BJA Educ"},{"key":"R39-20260414","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1007\/s00134-005-2819-6","article-title":"Outcome and changes over time in survival following severe burns from 1985 to 2004","volume":"31","author":"Brusselaers","year":"2005","journal-title":"Intensive Care Med"},{"key":"R40-20260414","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1097\/TA.0000000000004736","article-title":"Systems-based care of the injured child:Technical report","volume":"99","author":"Flynn-O'Brien","year":"2025","journal-title":"J Trauma Acute Care Surg"},{"key":"R41-20260414","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1089\/neu.2013.3094","article-title":"Prehospital use of cervical collars in trauma patients:A critical review","volume":"31","author":"Sundstr\u00f8m","year":"2014","journal-title":"J Neurotrauma"},{"key":"R42-20260414","doi-asserted-by":"crossref","first-page":"690","DOI":"10.4103\/ija.IJA_490_19","article-title":"Cardiovascular and respiratory physiology in children","volume":"63","author":"Saikia","year":"2019","journal-title":"Indian J Anaesth"},{"key":"R43-20260414","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1111\/acem.12344","article-title":"Occult pneumothoraces in children with blunt torso trauma","volume":"21","author":"Lee","year":"2014","journal-title":"Acad Emerg Med"},{"key":"R44-20260414","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1055\/s-0035-1554987","article-title":"Pediatric blunt thoracic trauma","volume":"4","author":"Alemayehu","year":"2015","journal-title":"J Pediatr Intensive Care"},{"key":"R45-20260414","doi-asserted-by":"crossref","first-page":"e1544","DOI":"10.1097\/PEC.0000000000002112","article-title":"Sound and air:Ultrasonographic measurements of pediatric chest wall thickness and implications for needle decompression of tension pneumothorax","volume":"37","author":"Hossain","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"R46-20260414","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1080\/10903127.2019.1566422","article-title":"Appropriate needle length for emergent pediatric needle thoracostomy utilizing computed tomography","volume":"23","author":"Mandt","year":"2019","journal-title":"Prehosp Emerg Care"},{"key":"R47-20260414","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1098\/rstb.2010.0252","article-title":"Blast injuries to the lung:Epidemiology and management","volume":"366","author":"Mackenzie","year":"2011","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"R48-20260414","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1007\/s00134-017-4920-z","article-title":"Recommendations for mechanical ventilation of critically ill children from the paediatric mechanical ventilation consensus conference (PEMVECC)","volume":"43","author":"Kneyber","year":"2017","journal-title":"Intensive Care Med"},{"key":"R52-20260414","doi-asserted-by":"crossref","first-page":"e2022060790","DOI":"10.1542\/peds.2022-060790","article-title":"Factors associated with improved pediatric resuscitative care in general emergency departments","volume":"152","author":"Auerbach","year":"2023","journal-title":"Pediatrics"},{"key":"R53-20260414","first-page":"e7424","article-title":"Kids really are just small adults:Utilizing the pediatric triangle with the classic ABCD approach to assess pediatric patients","volume":"12","author":"Walker","year":"2020","journal-title":"Cureus"},{"key":"R57-20260414","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00417-009-1292-2","article-title":"Clinical analysis of firework-related ocular injuries during spring festival 2009","volume":"248","author":"Jing","year":"2010","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R58-20260414","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1159\/000048298","article-title":"Ocular firework injuries at New Year's eve","volume":"216","author":"Sacu","year":"2002","journal-title":"Ophthalmologica"},{"key":"R59-20260414","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ajem.2016.10.008","article-title":"Analyses of sdemographical and injury characteristics of adult and pediatric patients injured in Syrian civil war","volume":"35","author":"Erhan","year":"2017","journal-title":"Am J Emerg Med"},{"key":"R60-20260414","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/PEC.0000000000003021","article-title":"Blast lung injury in children:Injury patterns and associated organ injuries","volume":"39","author":"Korkmaz","year":"2023","journal-title":"Pediatr Emerg Care"},{"key":"R61-20260414","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1098\/rstb.2010.0251","article-title":"The epidemiology of blast lung injury during recent military conflicts:A retrospective database review of cases presenting to deployed military hospitals, 2003-2009","volume":"366","author":"Smith","year":"2011","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"R62-20260414","doi-asserted-by":"crossref","first-page":"e568","DOI":"10.1093\/milmed\/usz453","article-title":"Primary blast lung injury:The UK military experience","volume":"185","author":"Scott","year":"2020","journal-title":"Mil Med"},{"key":"R63-20260414","doi-asserted-by":"crossref","first-page":"762","DOI":"10.7205\/MILMED-D-13-00513","article-title":"Pediatric surgery skill sets in role 3:The Afghanistan experience","volume":"179","author":"Mckechnie","year":"2014","journal-title":"Mil Med"},{"key":"R64-20260414","doi-asserted-by":"crossref","first-page":"107","DOI":"10.37897\/RJP.2019.2.2","article-title":"Abdominal hollow viscus trauma in children, injury mechanisms and treatment principles","volume":"68","author":"Tarca","year":"2019","journal-title":"Rom J Pediatr"},{"key":"R65-20260414","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/CORR.0000000000001642","article-title":"How common are civilian blast injuries in the national trauma databank, and what are the most common mechanisms and characteristics of associated injuries?","volume":"479","author":"Nunziato","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"R66-20260414","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.injury.2022.11.021","article-title":"Beirut massive blast explosion:A unique injury pattern of the wounded population","volume":"54","author":"Yammine","year":"2023","journal-title":"Injury"}],"container-title":["Turkish Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_381_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:43:58Z","timestamp":1787067838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_381_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":49,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/tjem.tjem_381_25","relation":{},"ISSN":["2452-2473","2452-2473"],"issn-type":[{"value":"2452-2473","type":"print"},{"value":"2452-2473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}