Pediatric Tourniquet Use: Safe and effective.

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.