title: Survey of trauma registry data on tourniquet use in pediatric war casualties.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Level 4; case series, therapeutic study.
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA. john.kragh1@us.army.mil
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D000293:Adolescent; D055826:Afghan Campaign 2001-; D001134:Arm Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004867:Equipment Design; D005260:Female; D019538:Health Care Surveys; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D054527:Mass Casualty Incidents; D012042:Registries; D012771:Shock, Hemorrhagic / Q000517:prevention & control; D014111:Tourniquets / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014857:Warfare; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality