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Published on: April 26, 2015
Pediatric Tourniquet Use: Safe and effective
Erin V Feeney1, Mariah R Harris2, Leah M Furman1
1University of Pittsburgh Medical Center, USA.
Insights
Tourniquet use in children with limb injuries is safe and feasible, with no adverse events reported in this study. Further research is needed to develop pediatric-specific guidelines for effective tourniquet application.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Medical Device Safety
Background:
- Tourniquet (TQ) use in pediatric trauma is guided by adult data, lacking specific pediatric evidence.
- This study evaluates the safety and feasibility of TQ application in children.
Purpose of the Study:
- To assess tourniquet use and safety in a pediatric cohort.
- To identify factors influencing proper TQ application in children.
- To evaluate adverse events associated with TQ use in pediatric patients.
Main Methods:
- Retrospective analysis of a pediatric level 1 trauma center database (2015-2022).
- Inclusion criteria: patients aged 0-17 years with traumatic limb injury and TQ application.
- Data collected: demographics, injury characteristics, TQ variables, and adverse events.
Main Results:
- 37 children (median age 14 years) received 51 TQs; 72% were male.
- 70% of injuries were penetrating; 19% of patients were in shock on arrival.
- No adverse complications related to TQ application were observed; 81% of TQs were properly applied.
Conclusions:
- Tourniquet application is feasible and safe in injured children.
- Larger studies are required to establish pediatric-specific evidence-based guidelines.
- Enhanced clinician training may improve the rate of proper tourniquet application.
Introduction:
Tourniquet (TQ) use is conditionally recommended in injured children largely on the basis of adult data. This investigation seeks to better understand tourniquet use and safety in a pediatric cohort.
Methods:
A pediatric level 1 trauma center database was queried retrospectively for patients aged 0-17 years who presented with traumatic limb injury and TQ application between 2015 and 2022. Data recorded included demographics, injury characteristics, TQ use variables (number, location, person applying, proper application) and adverse events (kidney injury, amputation, rhabdomyolysis, nerve injury, compartment syndrome). Data were summarized using counts, median, and percentages.
Results:
In total, 37 children who had a total of 51 TQs applied were included. Their median (IQR) age was 14 years (10-15), 27/37 and (72 %) were male. The median (IQR) injury severity score was 9 (5-10), mechanism of injury was 70 % penetrating, and 19 % (7/37) were in shock on arrival. Of the 37 children, 27 (73 %) required an urgent operation. The in-hospital mortality rate was 0 %, and 36/37 (97 %) were discharged home. In total, 11/51 (22 %) TQs were applied by bystanders, 21/51 (41 %) by Fire/EMS, 14/51 (32 %) by police, and 4/51 (8 %) by hospital clinical staff. Overall, 30/37 (81 %) had properly applied TQs. No patient had an adverse complication related to TQ application.
Conclusion:
In this cohort of injured children, tourniquet use was feasible and safe. Larger studies are needed to generate pediatric-specific evidence-based guidelines for TQ use; widespread clinician training may increase the rate of proper application.
Level Of Evidence:
Level 3, Cohort Study.
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