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

Croat Med J. 2001 Apr;42(2):156-60.


Aim: To analyze clinical course of war-related injuries in children treated at the Split University Hospital during the wars in Croatia (1991-1995) and 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 Injury Severity Score (ISS) evaluation systems.

Results: Most children were wounded during shelling/bombing (n = 28, 10 boys and 18 girls) and by left over explosive devices (n = 26). Children injured by left over explosive devices were predominantly boys (23/26 children), aged 10 to 16 years (19/26 children). Extremities were the most frequently wounded 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 antibiotic treatment (p < 0.05) most frequently, as well as patients with greater AIS and ISS scores (p < 0.05). According to the treatment outcome, more patients wounded to the abdomen and extremities showed improvement than no change or complete recovery (p < .05). Permanent disability remained in 37 (39.4%) 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 left over explosive devices than younger boys or girls. The most severe wounds were to the head/neck and the abdomen and inflicted during the shelling or bombing. This should be taken into account in organization of surgical care for the children with war-related injuries.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Analysis of Variance
  • Bosnia and Herzegovina / epidemiology
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Croatia / epidemiology
  • Female
  • Humans
  • Incidence
  • Injury Severity Score
  • Male
  • Registries
  • Risk Assessment
  • Risk Factors
  • Sex Distribution
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Survival Rate
  • Warfare*
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / epidemiology*