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Survey of Trauma Registry Data on Tourniquet Use in Pediatric War Casualties

Kragh, John F. Jr MD*†; Cooper, Arthur MD, MS; Aden, James K. PhD*; Dubick, Michael A. PhD*; Baer, David G. PhD*; Wade, Charles E. PhD§; Blackbourne, Lorne H. MD, MC, USA*

doi: 10.1097/PEC.0b013e318276c260
Original Articles

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.

From the *US Army Institute of Surgical Research, Fort Sam Houston, TX; †F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; ‡Department of Surgery, Harlem Hospital Center, College of Physicians and Surgeons Columbia University, New York, NY; and §University of Texas Health Science Center at Houston, Houston, TX.

Disclosure: The authors declare no conflicts of interest.

Reprints: John F. Kragh Jr, MD, US Army Institute of Surgical Research, Damage Control Resuscitation, 3698 Chambers Pass, Bldg BHT2 Room 222-4, Fort Sam Houston, TX 78234-6315 (e-mail:

Dr Kragh is an employee of the US Government and receives institutional support through the place where he works, the US Army Institute of Surgical Research. He has consulted at no cost with M2, Inc; Tiger Tourniquet, LLC; Tactical Medical Solutions, LLC; Combat Medical Systems, Inc; Composite Resources Inc; Delfi Medical Innovations, Inc; North American Rescue Products LLC; H & H Associates, Inc; Creative & Effective Technologies, Inc; TEMS Solutions, LLC; Blackhawk Products Group; Hemaclear; Tactical Development Group; Compression Works, LLC; Tier-One Quality Solutions; Kforce Government Solutions; CHI Systems; and Entrotech, Inc. He has received honoraria for work for the Food and Drug Administration for a device consultation. He has received honoraria for trustee work for the nonprofit Musculoskeletal Transplant Foundation. He has worked as a technical representative to the US Government’s contracting officer in agreements with Physical Optics Corporation; Resodyn Corporation; International Heart Institute of Montana Foundation; Daemen College; Noble Biomaterials, Inc; Wake Forest Institute of Regenerative Medicine; National Tissue Engineering Center; Pittsburgh Tissue Engineering Initiative; University of Texas Southwestern Medical Center; Arteriocyte, Inc; and Kelly Space and Technology, Inc. For the remaining authors none were declared. This project was funded with internal US Army Institute of Surgical Research funds and not from any of the following organizations: National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, or other.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or United States Government. The authors are employees of the US Government. This work was prepared as part of their official duties, and as such, there is no copyright to be transferred.

© 2012 Lippincott Williams & Wilkins, Inc.