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

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-10 DOI:10.1016/j.jpedsurg.2024.161955

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

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引用次数: 0

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.

查看原文本刊更多论文

青少年和儿童创伤性出血的院前止血带使用情况：一项全国性研究。

背景：止血带止血（TP）是控制出血的重要干预措施，但用于儿童的文献有限。本研究旨在评估不同医疗服务提供者（紧急医疗服务（EMS）、急救人员（FR）和旁观者）使用止血带的效果，假设所有医疗服务提供者对儿科创伤患者的治疗效果具有同等影响：我们使用国家急救医疗信息系统（NEMSIS）2017-2020 年的数据对 0-19 岁的患者进行了检查，并评估了止血带应用的效果。我们考虑了人口统计学、手术成功率、止血带使用时间与 EMS 到达时间的关系、修订创伤评分（RTS）以及急性期的改善情况。我们采用了多变量逻辑回归模型来预测止血带应用后的初始敏锐度和敏锐度改善的可能性，同时考虑了与患者和提供者相关的变量：共纳入 301 名患者，中位年龄为 17 岁，86.7% 为男性。在急救车到达之前，由任何医疗服务提供者进行 TP 都会降低急救车到达后出现危急情况的几率（OR = 0.84，CI = 0.76-0.94，P = 0.003）。急救人员到达后，与急救人员放置止血带相比，由旁观者和前线人员放置止血带与改善急性损伤几率相关（OR = 1.90，CI = 1.06-3.41，p = 0.03）。急救小组中只有一次止血失败（0.43%）。TP 失败与急性期改善的几率降低有关（OR = 0.62，CI = 0.44-0.86，P = 0.005）：结论：小儿创伤性出血的早期 TP 至关重要。结论：早期 TP 对小儿创伤性出血至关重要。在控制其他因素（包括 RTS 和急救到达时间）的情况下，由旁观者实施 TP 和 FR 与急性期的改善相关。这些发现强调了在院前环境中对所有医护人员进行TP培训的重要性：证据等级：IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.