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Pre-hospital Tourniquet Use in Adolescent and Pediatric Traumatic Hemorrhage: A National Study
Alice M Martino1, Andreina Giron2, John Schomberg3
1Department of Surgery, University of California Irvine, Irvine CA, USA.
Insights
Tourniquet placement in pediatric trauma patients by any provider before EMS arrival reduces critical acuity. Bystander and first responder tourniquets show improved outcomes compared to EMS placement.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Pediatric Critical Care
Background:
- Tourniquet placement (TP) is vital for hemorrhage control but understudied in pediatric populations.
- Limited data exists on the effectiveness of TP by non-EMS providers in children.
Purpose of the Study:
- To evaluate the effectiveness of tourniquet application in pediatric trauma patients.
- To compare outcomes based on the provider type: Emergency Medical Services (EMS), first responder (FR), or bystanders.
Main Methods:
- Analysis of National EMS Information Systems (NEMSIS) data from 2017-2020 for patients aged 0-19.
- Assessment of demographics, TP success, timing, Revised Trauma Score (RTS), and acuity improvement.
- Multivariable logistic regression to predict initial acuity and improvement post-TP.
Main Results:
- TP before EMS arrival was linked to lower odds of critical acuity (OR=0.84).
- Bystander and FR TP after EMS arrival showed higher odds of acuity improvement versus EMS TP (OR=1.90).
- TP failure was rare (0.43%) and associated with decreased acuity improvement (OR=0.62).
Conclusions:
- Early tourniquet application is critical for pediatric traumatic hemorrhage.
- TP by bystanders and FRs demonstrated improved acuity, highlighting the need for broad prehospital training.
- Tourniquet failures are infrequent, underscoring their safety and efficacy in pediatric trauma.
Background:
Tourniquet placement (TP) is a crucial intervention to control hemorrhage, but limited literature exists for use in children. This study aimed to evaluate the effectiveness of tourniquet application by different providers (Emergency Medical Services (EMS), first responder (FR), and bystanders), hypothesizing equivalent impact on outcomes for pediatric trauma patients for all providers.
Methods:
Data from the National EMS Information Systems (NEMSIS) 2017-2020 was used to examine patients 0-19 years old and assess the outcomes of tourniquet application. We considered demographics, procedure success, timing of TP relative to EMS arrival, revised trauma score (RTS), and improvement in acuity. Multivariable logistic regression models were employed to predict initial acuity and likelihood of acuity improvement after TP, while accounting for patient and provider-related variables.
Results:
301 patients were included with a median age of 17 and 86.7 % male. TP by any provider before EMS transport arrival was associated with reduced odds of critical acuity upon EMS arrival (OR = 0.84, CI = 0.76-0.94, p = 0.003). After EMS arrival, bystander- and FR-placed tourniquets were associated with increased odds of improved acuity compared to EMS-placed tourniquets (OR = 1.90, CI = 1.06-3.41, p = 0.03). There was only one TP failure (0.43 %) in the EMS group. TP failure was associated with decreased odds of acuity improvement (OR = 0.62, CI = 0.44-0.86, p = 0.005).
Conclusion:
Early TP for pediatric traumatic hemorrhage is crucial. Failures were rare. Placement by bystanders and FR were associated with improved acuity when controlling for other factors including RTS and EMS arrival time. These findings emphasize the importance of training on TP for all providers in prehospital settings.
Level Of Evidence:
IV.
