Survey of trauma registry data on tourniquet use in pediatric war casualties

Pediatr Emerg Care. 2012 Dec;28(12):1361-5. doi: 10.1097/PEC.0b013e318276c260.


Objectives: Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training.

Methods: A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009.

Results: Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use.

Conclusions: The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training.

Levels of evidence: Level 4; case series, therapeutic study.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Afghan Campaign 2001-
  • Arm Injuries / complications
  • Arm Injuries / epidemiology
  • Arm Injuries / therapy
  • Body Size
  • Child
  • Child, Preschool
  • Emergencies*
  • Equipment Design
  • Female
  • Health Care Surveys*
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology
  • Hemorrhage / therapy*
  • Hospitals, Military / statistics & numerical data*
  • Humans
  • Iraq War, 2003-2011
  • Leg Injuries / complications
  • Leg Injuries / epidemiology
  • Leg Injuries / therapy
  • Length of Stay / statistics & numerical data
  • Male
  • Mass Casualty Incidents*
  • Registries*
  • Shock, Hemorrhagic / prevention & control
  • Tourniquets / statistics & numerical data*
  • Trauma Severity Indices
  • United States
  • Unnecessary Procedures / statistics & numerical data
  • Warfare*
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / etiology
  • Wounds and Injuries / mortality