Boosting Pediatric Survival: Early Tourniquet Use Linked to Improved Outcomes

Boosting Pediatric Survival: Early Tourniquet Use Linked to Improved Outcomes

November 27, 2024 Catherine Williams Health

TOPLINE:

Tourniquets placed on children with trauma before emergency medical services (EMS) arrive lead to better patient outcomes. Bystanders and first responders show high success rates in applying tourniquets.

METHODOLOGY:

  • Researchers studied 301 children with traumatic bleeding (average age 17 years; 86.7% boys) from the National EMS Information System over four years (2017-2020).
  • Tourniquets were applied before EMS arrival in 187 cases and after in 105 cases.
  • Key outcomes measured included the success of tourniquet application and changes in patient health status from injury to hospital.

FINDINGS:

  • Children with tourniquets applied before EMS arrival had lower critical health rates (18.1%) compared to those treated after arrival (36.6%).
  • Emergency department statistics mirrored these results: 21.0% vs. 35.2% for critical acuity at hospital arrival.
  • More than half of the patients in both groups showed acuity improvement post-treatment.
  • First responders and bystanders placed tourniquets before EMS arrival more often than after (14.7% and 9.6%, respectively).
  • Tourniquet placement prior to EMS arrival reduced initial acuity (odds ratio [OR], 0.84).
  • Tourniquets applied by bystanders or responders after EMS arrival increased the chances of improved acuity (OR, 1.90).
  • Success rates for tourniquet application were nearly 100%, with only a 0.43% failure rate in the EMS group. Failed applications decreased the odds of improvement (OR, 0.62).

IN PRACTICE:

Tourniquets can control bleeding and save lives, even in rare pediatric trauma cases. The study confirms that EMS, first responders, and bystanders have similar success rates. However, early application by non-EMS providers correlates with better patient outcomes.

SOURCE:

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

LIMITATIONS:

Data limitations included inconsistent EMS reporting, missing information, exclusion of fatal cases, and selection bias. There were no patient-centered data on pain or quality of life post-treatment, limiting long-term outcome assessments. Findings may not apply to other countries due to differences in data and EMS systems.

DISCLOSURES:

The authors reported no funding sources or conflicts of interest.

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