A multi-institutional analysis of prehospital tourniquet use

Rebecca Schroll, Alison Smith, Norman E. McSwain, John Myers, Kristin Rocchi, Kenji Inaba, Stefano Siboni, Gary A. Vercruysse, Irada Ibrahim-Zada, Jason L. Sperry, Christian Martin-Gill, Jeremy W. Cannon, Seth R. Holland, Martin Schreiber, Diane Lape, Alexander L. Eastman, Cari S. Stebbins, Paula Ferrada, Jinfeng Han, Peter MeadeJuan C. Duchesne

    Research output: Contribution to journalArticle

    45 Citations (Scopus)

    Abstract

    BACKGROUND: Recent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to compare outcomes to previously published military experience. We hypothesized that incorporation of tourniquet use in the civilian population will result in an overall improvement in mortality. METHODS: This is a preliminary multi-institutional retrospective analysis of prehospital tourniquet (MIA-T) use of patients admitted to nine urban Level 1 trauma centers from January 2010 to December 2013. Patient demographics and mortality from a previous military experience by Kragh et al. (Ann Surg. 2009;249:1-7) were used for comparison. Patients younger than 18 years or with nontraumatic bleeding requiring tourniquet application were excluded. Data were analyzed using a two-tailed unpaired Student's t test with p <0.05 as significant. RESULTS: A total of 197 patients were included. Tourniquets were applied effectively in 175 (88.8%) of 197 patients. The average Injury Severity Score (ISS) for MIA-T versus military was 11 ± 12.5 versus 14 ± 10.5, respectively (p = 0.02). The overall mortality and limb amputation rates for the MIA-T group were significantly lower than previously seen in the military population at 6 (3.0%) of 197 versus 22 (11.3%) of 194 (p = 0.002) and 37 (18.8%) of 197 versus 97 (41.8%) of 232 (p = 0.0001), respectively. CONCLUSION: Our study is the largest evaluation of prehospital tourniquet use in a civilian population to date. We found that tourniquets were applied safely and effectively in the civilian population. Adaptation of this prehospital intervention may convey a survival benefit in the civilian population. LEVEL OF EVIDENCE: Epidemiologic study, level V.

    Original languageEnglish (US)
    Pages (from-to)10-14
    Number of pages5
    JournalJournal of Trauma and Acute Care Surgery
    Volume79
    Issue number1
    DOIs
    StatePublished - Jul 3 2015

    Fingerprint

    Tourniquets
    Population
    Mortality
    Injury Severity Score
    Survival
    Trauma Centers
    Amputation
    Epidemiologic Studies
    Extremities
    Demography
    Hemorrhage
    Students

    Keywords

    • civilian
    • multi-institutional
    • prehospital
    • Tourniquet
    • trauma

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery
    • Medicine(all)

    Cite this

    Schroll, R., Smith, A., McSwain, N. E., Myers, J., Rocchi, K., Inaba, K., ... Duchesne, J. C. (2015). A multi-institutional analysis of prehospital tourniquet use. Journal of Trauma and Acute Care Surgery, 79(1), 10-14. https://doi.org/10.1097/TA.0000000000000689

    A multi-institutional analysis of prehospital tourniquet use. / Schroll, Rebecca; Smith, Alison; McSwain, Norman E.; Myers, John; Rocchi, Kristin; Inaba, Kenji; Siboni, Stefano; Vercruysse, Gary A.; Ibrahim-Zada, Irada; Sperry, Jason L.; Martin-Gill, Christian; Cannon, Jeremy W.; Holland, Seth R.; Schreiber, Martin; Lape, Diane; Eastman, Alexander L.; Stebbins, Cari S.; Ferrada, Paula; Han, Jinfeng; Meade, Peter; Duchesne, Juan C.

    In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 1, 03.07.2015, p. 10-14.

    Research output: Contribution to journalArticle

    Schroll, R, Smith, A, McSwain, NE, Myers, J, Rocchi, K, Inaba, K, Siboni, S, Vercruysse, GA, Ibrahim-Zada, I, Sperry, JL, Martin-Gill, C, Cannon, JW, Holland, SR, Schreiber, M, Lape, D, Eastman, AL, Stebbins, CS, Ferrada, P, Han, J, Meade, P & Duchesne, JC 2015, 'A multi-institutional analysis of prehospital tourniquet use', Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 10-14. https://doi.org/10.1097/TA.0000000000000689
    Schroll, Rebecca ; Smith, Alison ; McSwain, Norman E. ; Myers, John ; Rocchi, Kristin ; Inaba, Kenji ; Siboni, Stefano ; Vercruysse, Gary A. ; Ibrahim-Zada, Irada ; Sperry, Jason L. ; Martin-Gill, Christian ; Cannon, Jeremy W. ; Holland, Seth R. ; Schreiber, Martin ; Lape, Diane ; Eastman, Alexander L. ; Stebbins, Cari S. ; Ferrada, Paula ; Han, Jinfeng ; Meade, Peter ; Duchesne, Juan C. / A multi-institutional analysis of prehospital tourniquet use. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 1. pp. 10-14.
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    abstract = "BACKGROUND: Recent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to compare outcomes to previously published military experience. We hypothesized that incorporation of tourniquet use in the civilian population will result in an overall improvement in mortality. METHODS: This is a preliminary multi-institutional retrospective analysis of prehospital tourniquet (MIA-T) use of patients admitted to nine urban Level 1 trauma centers from January 2010 to December 2013. Patient demographics and mortality from a previous military experience by Kragh et al. (Ann Surg. 2009;249:1-7) were used for comparison. Patients younger than 18 years or with nontraumatic bleeding requiring tourniquet application were excluded. Data were analyzed using a two-tailed unpaired Student's t test with p <0.05 as significant. RESULTS: A total of 197 patients were included. Tourniquets were applied effectively in 175 (88.8{\%}) of 197 patients. The average Injury Severity Score (ISS) for MIA-T versus military was 11 ± 12.5 versus 14 ± 10.5, respectively (p = 0.02). The overall mortality and limb amputation rates for the MIA-T group were significantly lower than previously seen in the military population at 6 (3.0{\%}) of 197 versus 22 (11.3{\%}) of 194 (p = 0.002) and 37 (18.8{\%}) of 197 versus 97 (41.8{\%}) of 232 (p = 0.0001), respectively. CONCLUSION: Our study is the largest evaluation of prehospital tourniquet use in a civilian population to date. We found that tourniquets were applied safely and effectively in the civilian population. Adaptation of this prehospital intervention may convey a survival benefit in the civilian population. LEVEL OF EVIDENCE: Epidemiologic study, level V.",
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    AU - Schroll, Rebecca

    AU - Smith, Alison

    AU - McSwain, Norman E.

    AU - Myers, John

    AU - Rocchi, Kristin

    AU - Inaba, Kenji

    AU - Siboni, Stefano

    AU - Vercruysse, Gary A.

    AU - Ibrahim-Zada, Irada

    AU - Sperry, Jason L.

    AU - Martin-Gill, Christian

    AU - Cannon, Jeremy W.

    AU - Holland, Seth R.

    AU - Schreiber, Martin

    AU - Lape, Diane

    AU - Eastman, Alexander L.

    AU - Stebbins, Cari S.

    AU - Ferrada, Paula

    AU - Han, Jinfeng

    AU - Meade, Peter

    AU - Duchesne, Juan C.

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    N2 - BACKGROUND: Recent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to compare outcomes to previously published military experience. We hypothesized that incorporation of tourniquet use in the civilian population will result in an overall improvement in mortality. METHODS: This is a preliminary multi-institutional retrospective analysis of prehospital tourniquet (MIA-T) use of patients admitted to nine urban Level 1 trauma centers from January 2010 to December 2013. Patient demographics and mortality from a previous military experience by Kragh et al. (Ann Surg. 2009;249:1-7) were used for comparison. Patients younger than 18 years or with nontraumatic bleeding requiring tourniquet application were excluded. Data were analyzed using a two-tailed unpaired Student's t test with p <0.05 as significant. RESULTS: A total of 197 patients were included. Tourniquets were applied effectively in 175 (88.8%) of 197 patients. The average Injury Severity Score (ISS) for MIA-T versus military was 11 ± 12.5 versus 14 ± 10.5, respectively (p = 0.02). The overall mortality and limb amputation rates for the MIA-T group were significantly lower than previously seen in the military population at 6 (3.0%) of 197 versus 22 (11.3%) of 194 (p = 0.002) and 37 (18.8%) of 197 versus 97 (41.8%) of 232 (p = 0.0001), respectively. CONCLUSION: Our study is the largest evaluation of prehospital tourniquet use in a civilian population to date. We found that tourniquets were applied safely and effectively in the civilian population. Adaptation of this prehospital intervention may convey a survival benefit in the civilian population. LEVEL OF EVIDENCE: Epidemiologic study, level V.

    AB - BACKGROUND: Recent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to compare outcomes to previously published military experience. We hypothesized that incorporation of tourniquet use in the civilian population will result in an overall improvement in mortality. METHODS: This is a preliminary multi-institutional retrospective analysis of prehospital tourniquet (MIA-T) use of patients admitted to nine urban Level 1 trauma centers from January 2010 to December 2013. Patient demographics and mortality from a previous military experience by Kragh et al. (Ann Surg. 2009;249:1-7) were used for comparison. Patients younger than 18 years or with nontraumatic bleeding requiring tourniquet application were excluded. Data were analyzed using a two-tailed unpaired Student's t test with p <0.05 as significant. RESULTS: A total of 197 patients were included. Tourniquets were applied effectively in 175 (88.8%) of 197 patients. The average Injury Severity Score (ISS) for MIA-T versus military was 11 ± 12.5 versus 14 ± 10.5, respectively (p = 0.02). The overall mortality and limb amputation rates for the MIA-T group were significantly lower than previously seen in the military population at 6 (3.0%) of 197 versus 22 (11.3%) of 194 (p = 0.002) and 37 (18.8%) of 197 versus 97 (41.8%) of 232 (p = 0.0001), respectively. CONCLUSION: Our study is the largest evaluation of prehospital tourniquet use in a civilian population to date. We found that tourniquets were applied safely and effectively in the civilian population. Adaptation of this prehospital intervention may convey a survival benefit in the civilian population. LEVEL OF EVIDENCE: Epidemiologic study, level V.

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    KW - multi-institutional

    KW - prehospital

    KW - Tourniquet

    KW - trauma

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