Mortality from isolated civilian penetrating extremity injury

W. C. Dorlac, M. E. DeBakey, John B. Holcomb, S. P. Pagan, K. L. Kwong, G. R. Dorlac, M. A. Schreiber, D. E. Persse, F. A. Moore, K. L. Mattox

    Research output: Contribution to journalReview article

    118 Scopus citations

    Abstract

    Background: Although studies have ascertained that ten percent of soldiers killed in battle bleed to death from extremity wounds, little data exists on exsanguination and mortality from extremity injuries in civilian trauma. This study examined the treatment course and outcomes of civilian patients who appear to have exsanguinated from isolated penetrating extremity injuries. Methods: Five and 1/2 years' data (Aug 1994 to Dec 1999) were reviewed from two Level I trauma centers that receive 95% of trauma patients in metropolitan Houston, TX. Records (hospital trauma registries, emergency medical system (EMS) and medical examiner data) were reviewed on all patients with isolated extremity injuries who arrived dead at the trauma center or underwent cardiopulmonary resuscitation (CPR) or emergency center thoracotomy (ECT). Results: Fourteen patients meeting inclusion criteria were identified from over 75,000 trauma emergency center (EC) visits. Average age was 31 years and 93% were males. Gunshot wounds accounted for 50% of the injuries. The exsanguinating wound was in the lower extremity in 10/14 (71%) patients and proximal to the elbow or knee in 12/14 (86%). Ten (71%) had both a major artery and vein injured; one had only a venous injury. Prehospital hemorrhage control was primarily by gauze dressings. Twelve (86%) had "signs of life" in the field, but none had a discernable blood pressure or pulse upon arrival at the EC. Prehospital intravenous access was not obtained in 10 patients (71%). Nine patients underwent ECT, and nine were initially resuscitated (eight with ECT and one with CPR). Those undergoing operative repair received an average of 26 ± 14 units of packed red blood cells. All patients died, 93% succumbing within 12 hours. Conclusion: Although rare, death from isolated extremity injuries does occur in the civilian population. The majority of injuries that lead to immediate death are proximal injuries of the lower extremities. The cause of death in this series appears to have been exsanguination, although definitive etiology cannot be discerned. Intravenous access was not obtainable in the majority of patients. Eight patients (57%) had bleeding from a site that anatomically might have been amenable to tourniquet control. Patients presenting to the EC without any detectable blood pressure and who received either CPR or EC thoracotomy all died.

    Original languageEnglish (US)
    Pages (from-to)217-222
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume59
    Issue number1
    DOIs
    StatePublished - Jul 2005

    Keywords

    • Extremity injury tourniquet emergency thoracotomy
    • Trauma exsanguination extremity EMS

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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  • Cite this

    Dorlac, W. C., DeBakey, M. E., Holcomb, J. B., Pagan, S. P., Kwong, K. L., Dorlac, G. R., Schreiber, M. A., Persse, D. E., Moore, F. A., & Mattox, K. L. (2005). Mortality from isolated civilian penetrating extremity injury. Journal of Trauma - Injury, Infection and Critical Care, 59(1), 217-222. https://doi.org/10.1097/01.TA.0000173699.71652.BA