Pre-hospital Tourniquet Use in Adolescent and Pediatric Traumatic Hemorrhage: A National Study

Alice M Martino; Andreina Giron; John Schomberg; Makenzie Ferguson; Jeffry Nahmias; Sigrid Burruss; Yigit Guner; Laura F Goodman

doi:10.1016/j.jpedsurg.2024.161955

Pre-hospital Tourniquet Use in Adolescent and Pediatric Traumatic Hemorrhage: A National Study

J Pediatr Surg. 2024 Oct 10;60(1):161955. doi: 10.1016/j.jpedsurg.2024.161955. Online ahead of print.

Authors

Alice M Martino¹, Andreina Giron², John Schomberg³, Makenzie Ferguson⁴, Jeffry Nahmias⁵, Sigrid Burruss⁵, Yigit Guner⁶, Laura F Goodman⁶

Affiliations

¹ Department of Surgery, University of California Irvine, Irvine CA, USA. Electronic address: alicemm1@hs.uci.edu.
² Division of Pediatric Surgery, Children's Hospital of Orange County, Orange CA, USA.
³ CHOC Research Institute, Children's Hospital of Orange County, Orange CA, USA.
⁴ Department of Trauma Services at CHOC Children's Hospital of Orange County, USA.
⁵ Department of Surgery, University of California Irvine, Irvine CA, USA; Division of Trauma, Burns, Critical Care, & Acute Care Surgery, University of California Irvine, Orange, CA USA.
⁶ Department of Surgery, University of California Irvine, Irvine CA, USA; Division of Pediatric Surgery, Children's Hospital of Orange County, Orange CA, USA.

PMID: 39442327
DOI: 10.1016/j.jpedsurg.2024.161955

Abstract

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.

Keywords: Hemorrhage; Pediatric injury; Pediatric trauma; Stop the bleed; Tourniquet.