Feeney Erin V, Harris Mariah R, Furman Leah M, Gaines Barbara A, Leeper Christine M
University of Pittsburgh Medical Center, USA.
Lincoln University, USA.
J Pediatr Surg. 2025 Oct;60(10):162494. doi: 10.1016/j.jpedsurg.2025.162494. Epub 2025 Jul 30.
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.
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.
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.
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 3, Cohort Study.
在很大程度上基于成人数据，有条件地建议在受伤儿童中使用止血带（TQ）。本研究旨在更好地了解儿科队列中止血带的使用情况和安全性。
对一家儿科一级创伤中心数据库进行回顾性查询，以获取2015年至2022年间出现肢体创伤并应用止血带的0至17岁患者的信息。记录的数据包括人口统计学、损伤特征、止血带使用变量（数量、位置、应用者、正确应用情况）和不良事件（肾损伤、截肢、横纹肌溶解、神经损伤、骨筋膜室综合征）。数据使用计数、中位数和百分比进行汇总。
总共纳入了37名应用了51次止血带的儿童。他们的中位（四分位间距）年龄为14岁（10 - 15岁），27/37（72%）为男性。中位（四分位间距）损伤严重程度评分为9分（5 - 10分），损伤机制为70%为穿透伤，19%（7/37）到达时处于休克状态。37名儿童中，27名（73%）需要紧急手术。院内死亡率为0%，36/37（97%）出院回家。总共11/51（22%）的止血带由旁观者应用，21/51（41%）由消防/急救医疗服务人员应用，14/51（32%）由警察应用，4/51（8%）由医院临床工作人员应用。总体而言，30/37（81%）的止血带应用正确。没有患者出现与止血带应用相关的不良并发症。
在这个受伤儿童队列中，止血带的使用是可行且安全的。需要开展更大规模的研究以制定针对儿科的基于证据的止血带使用指南；广泛的临床医生培训可能会提高正确应用率。
3级，队列研究。
