Tourniquet use for civilian extremity trauma.
The journal of trauma and acute care surgery · 2015-07-29 · Observational study
Abstract
BACKGROUND: Unlike in the military setting, where the use of tourniquets has been well established, in the civilian sector their use has been far less uniform. The purpose of this study was to examine the outcomes associated with the use of tourniquets for civilian extremity trauma. STUDY DESIGN: Adult (≥18 years) patients admitted to our institution with an extremity injury requiring tourniquet application from January 2007 to June 2014 were retrospectively reviewed. The primary outcome analyzed was limb loss. Secondary outcomes included death, hospital length of stay, and complications. RESULTS: There were 87 patients who met inclusion criteria. Average age was 35.3 years, 90.8% were male, and 66.7% had penetrating injuries, with a median Injury Severity Score (ISS) of 6. Tourniquets were placed in the prehospital setting in 50.6%, in the emergency department in 39.1%, and in the operating room in 10.3% of patients. The windlass type Combat Application Tourniquet was the most commonly used type (67.8%), followed by a pneumatic system (24.1%) and self-made tourniquet (8.0%). The median duration of use was 75 minutes (interquartile range, 91) with no differences between groups (p = 0.547). Overall, 80.5% had a vascular injury (70.1% arterial), and a total of 99 limb operations were performed, including 15 amputations. Fourteen amputations (93.3%) occurred at the scene or were directly attributed to the extent of tissue damage with a median Mangled Extremity Severity Score (MESS) of 7 (interquartile range, 2). In the remaining patient, the tourniquet was lifesaving but likely contributed to limb loss. Seven patients sustained 13 other complications; however, none was directly attributed to tourniquet use. CONCLUSION: Tourniquet use in the civilian sector is associated with a low rate of complications. With the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Mortality & survival · Tourniquet
Related articles
- Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis. (Medicina (Kaunas), 2025)
- Effectiveness and safety of tourniquet utilization for civilian vascular extremity trauma in the pre-hospital settings: a systematic review and meta-analysis. (World J Emerg Surg, 2024)
- Systematic review of prehospital tourniquet use in civilian limb trauma. (J Trauma Acute Care Surg, 2018)
- The effects of military-wide introduction of advanced tourniquets in the Israel Defense Forces. (Injury, 2020)
- Characterizing pediatric supermassive transfusion and the contributing injury patterns in the combat environment. (Am J Emerg Med, 2022)
- Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. (Int J Environ Res Public Health, 2021)