Early Tourniquet Use Linked to Improved Pediatric Outcomes

TOPLINE:

In children with traumatic hemorrhage, tourniquets placed before the arrival of emergency medical services (EMSs) are associated with decreased initial acuity, and all providers, including bystanders and first responders, demonstrate high procedural success rates.

METHODOLOGY:

• The researchers analyzed 301 children with traumatic hemorrhage (median age,17 years; 86.7% boys) from the National EMS Information System database over 4 years (2017-2020).
• Tourniquets were placed before EMS transport arrival in 187 patients and after arrival in 105 patients.
• The primary outcomes were the success of tourniquet application and changes in patient acuity from the scene of injury to hospital arrival.

TAKEAWAY:

• Patients with tourniquets placed before vs after EMS arrival were less likely to have critical acuity at EMS arrival (18.1% vs 36.6%; P =.002) and emergency department arrival (21.0% vs 35.2%; P <.0001 acuity="" after="" between="" both="" did="" differ="" groups="" groups.="" half="" improvement="" in="" more="" not="" of="" patients="" placement="" showing="" significantly="" than="" the="" with="">
• First responders and bystanders were more likely to place tourniquets before EMS transport arrival than after arrival (14.7% and 9.6%, respectively). Tourniquet placement prior to EMS arrival was associated with a decrease in initial acuity (odds ratio [OR], 0.84; P =.003).
• Placement by bystanders or first responders after EMS arrival increased the odds of improved acuity (OR, 1.90; P =.03).
• Success rates for initial tourniquet application were nearly 100% across all providers, with only 0.43% failures in the EMS group; failed placement of tourniquets reduced the likelihood of improved acuity(OR, 0.62; P =.005).

IN PRACTICE:

“While exsanguinating hemorrhage is rare in the pediatric population, tourniquets have the potential to control bleeding and save lives,” the authors wrote. “EMS, first responders, and bystanders had comparable rates of tourniquet placement success. However, first responders and bystanders were more likely to place tourniquets prior to EMS transport arrival, and placement by first responders or bystander was associated with increased odds of improved acuity on arrival to the treatment facility, when adjusted for factors such as injury severity,” they added.

SOURCE:

The study was led by Alice M. Martino, Department of Surgery, University of California Irvine, and was published online on October 10, 2024, in the Journal of Pediatric Surgery.

LIMITATIONS:

The data were limited due to variations in EMS reporting practices, missing variables, the exclusion of patients with fatal injuries, selection bias, and the lack of data on hospitalization or postdischarge outcomes. The absence of patient-centric data, including pain and quality of life measures, makes it challenging to assess the long-term outcomes of tourniquet usage, and the findings may not be generalizable due to differences in US data and prehospital systems in other countries.

DISCLOSURES:

The authors did not disclose any funding source or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.