From the Division of Trauma, Emergency Surgery and Surgical Critical Care (S.M., A.K.M., C.M.L., K.A.B., B.L., H.M.A.K., G.V., A.E.M., N.S.), Massachusetts General Hospital, Boston, Harvard Medical School, Boston, Massachusetts; and Department of Trauma Surgery (S.M., F.W.B.), Amsterdam UMC, Amsterdam, the Netherlands.
J Trauma Acute Care Surg. 2021 Aug 1;91(2):352-360. doi: 10.1097/TA.0000000000003247.
Prehospital tourniquet (PHT) utilization has increased in response to mass casualty events. We aimed to describe the incidence, therapeutic effectiveness, and morbidity associated with tourniquet placement in all patients treated with PHT application.
A retrospective observational cohort study was performed to evaluate all adults with a PHT who presented at two Level I trauma centers between January 2015 and December 2019. Medically trained abstractors determined if the PHT was clinically indicated (placed for limb amputation, vascular hard signs, injury requiring hemostasis procedure, or significant documented blood loss). Prehospital tourniquets were further designated as appropriately or inappropriately applied (based on PHT anatomic placement location, occurrence of a venous tourniquet, or ischemic time defined as >2 hours). Statistical analyses were performed to generate primary and secondary results.
A total of 147 patients met study inclusion criteria, of which 70% met the criteria for trauma registry inclusion. Total incidence of PHT utilization increased from 2015 to 2019, with increasing proportions of PHTs placed by nonemergency medical service personnel. Improvised PHTs were frequently used. Prehospital tourniquets were clinically indicated in 51% of patients. Overall, 39 (27%) patients had a PHT that was inappropriately placed, five of which resulted in significant morbidity.
In summary, prehospital tourniquet application has become widely adopted in the civilian setting, frequently performed by civilian and nonemergency medical service personnel. Of PHTs placed, nearly half had no clear indication for placement and over a quarter of PHTs were misapplied with notable associated morbidity. Results suggest that the topics of clinical indication and appropriate application of tourniquets may be important areas for continued focus in future tourniquet educational programs, as well as future quality assessment efforts.
Epidemiological, level III; Therapeutic, level IV.
为应对大规模伤亡事件，院前止血带（PHT）的使用有所增加。我们旨在描述所有使用 PHT 治疗的患者中止血带放置的发生率、治疗效果和发病率。
对 2015 年 1 月至 2019 年 12 月在两家一级创伤中心就诊的所有使用 PHT 的成年人进行回顾性观察队列研究。受过医学培训的摘要员确定 PHT 是否具有临床指征（用于肢体截肢、血管硬体征、需要止血程序的损伤或明显记录的失血）。院前止血带进一步指定为适当或不适当应用（基于止血带解剖放置位置、出现静脉止血带或缺血时间定义为>2 小时）。进行了统计分析以生成主要和次要结果。
共有 147 名患者符合研究纳入标准，其中 70%符合创伤登记册纳入标准。PHT 使用的总发生率从 2015 年到 2019 年增加，越来越多的 PHT 由非紧急医疗服务人员放置。临时止血带经常使用。51%的患者使用 PHT 具有临床指征。总体而言，39 名（27%）患者的 PHT 放置不当，其中 5 名患者出现严重的发病率。
总之，院前止血带的应用已在民用环境中广泛采用，通常由民用和非紧急医疗服务人员进行。放置的止血带中，近一半没有明确的放置指征，超过四分之一的止血带应用不当，与明显相关的发病率有关。结果表明，临床指征和止血带的适当应用可能是未来止血带教育计划以及未来质量评估工作的重要关注领域。
流行病学，III 级；治疗，IV 级。
