Prehosp Emerg Care. 2022 Mar-Apr;26(2):246-254. doi: 10.1080/10903127.2020.1868635. Epub 2021 Feb 2.
Uncontrolled bleeding is a preventable cause of death in rural trauma. Herein, we examined the appropriateness, effectiveness, and safety of tourniquet application for bleeding control in a rural trauma system. Medical records of adult patients admitted to our academic Level I trauma center between July 2015 and December 2018 were retrospectively reviewed. Demographics (age, gender), injury (Injury severity score, Glascow Coma scale, mechanism of injury), tourniquet (type, tourniquet application site, tourniquet duration, place of application and removal, indication), and outcome data (complications such as amputation, acute kidney injury, rhabdomyolysis, or nerve palsy and mortality) were collected. Tourniquet indications, effectiveness, and complications were evaluated. Data were compared to those in urban settings. Ninety-two patients (94 tourniquets) were identified, of which 58.7% incurred penetrating injuries. Eighty-seven tourniquets (92.5%) were applied in the prehospital setting. Twenty tourniquets (21.3%) were applied to patients without an appropriate indication. Two of these tourniquets were applied in a hospital setting, while 18 occurred in the prehospital setting ( = 0.638). Patients with a non-indicated tourniquet presented with a higher hemoglobin level on admission, received less packed red blood cell units within the first 24 hours of hospitalization, and were less likely to require surgery for hemostasis. None of the non-indicated tourniquets led to a complication. Indicated tourniquets were deemed ineffective in seven cases (9.5%); they were all applied in the prehospital setting. The average tourniquet time was 123 min in rural vs. 48 min in urban settings, < 0.001. There was no significant difference in mortality, amputation rates and incidence of nerve palsy between the rural and urban settings. Even with long transport times, early tourniquet application for hemorrhage control in rural settings is safe with no significant attributable morbidity and mortality compared to published studies on urban civilian tourniquet use. The observed rates of non-indicated and ineffective tourniquets indicate suboptimal tourniquet usage and application. Opportunity exists for standardized hemorrhage control training on the use of direct pressure and pressure dressings, indications for tourniquet use, and effective tourniquet application.
在农村创伤中，无法控制的出血是可预防的死亡原因。在此，我们研究了在农村创伤系统中使用止血带控制出血的适当性、有效性和安全性。回顾性分析了 2015 年 7 月至 2018 年 12 月期间我院学术一级创伤中心收治的成年患者的病历。收集了人口统计学资料（年龄、性别）、损伤（损伤严重程度评分、格拉斯哥昏迷评分、损伤机制）、止血带（类型、止血带应用部位、止血带应用时间、应用和去除部位、适应证）和结局数据（并发症，如截肢、急性肾损伤、横纹肌溶解或神经麻痹和死亡率）。评估了止血带的适应证、效果和并发症。并与城市环境的数据进行了比较。确定了 92 例患者（94 个止血带），其中 58.7%为穿透性损伤。87 个止血带（92.5%）在院前环境中应用。20 个止血带（21.3%）应用于没有适当适应证的患者。其中 2 个在医院环境中应用，而 18 个在院前环境中应用（ = 0.638）。使用非适应证止血带的患者入院时血红蛋白水平较高，入院后 24 小时内接受的浓缩红细胞单位较少，且不太需要手术止血。没有一个非适应证止血带导致并发症。7 例（9.5%）有适应证的止血带被认为无效；它们都在院前环境中应用。农村地区止血带的平均使用时间为 123 分钟，而城市地区为 48 分钟， < 0.001。农村和城市地区的死亡率、截肢率和神经麻痹发生率无显著差异。即使转运时间较长，与城市平民使用止血带的已发表研究相比，农村地区早期使用止血带控制出血是安全的，没有明显的可归因发病率和死亡率。非适应证和无效止血带的观察发生率表明止血带的使用和应用并不理想。有机会对直接压迫和压力敷料的使用、止血带使用的适应证以及有效止血带应用进行标准化的出血控制培训。
