Department of Surgery, 12258Louisiana State University Health Science Center, New Orleans, LA, USA.
Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA.
Am Surg. 2022 Sep;88(9):2103-2107. doi: 10.1177/00031348221088968. Epub 2022 Apr 17.
Combat applications of tourniquets for extremity trauma have led to increased civilian prehospital tourniquet use. Studies have demonstrated that appropriate prehospital tourniquet application can decrease the incidence of arrival in shock without increasing limb complications. The aim of this study was to examine outcomes of prehospital tourniquet placement without definitive vascular injury.
Retrospective review was performed of a prospectively maintained database by the American Association for the Surgery of Trauma from 29 trauma centers. Patients in this subset analysis did not have a significant vascular injury as determined by imaging or intra-operatively. Patients who received prehospital tourniquets (PHTQ) were compared to patients without prehospital tourniquets (No-PHTQ). Outcomes were amputation rates, nerve palsy, compartment syndrome, and in-hospital mortality.
A total of 622 patients had no major vascular injury. The incidence of patients without major vascular injury was higher in the PHTQ group (n = 585/962, 60.8 vs n = 37/88, 42.0%, < .001). Cohorts were similar in age, gender, penetrating mechanism, injury severity scores (ISS), abbreviated injury score (AIS), and mortality ( > .05). Amputation rates were 8.3% (n = 49/585) in the PHTQ group compared to 0% (n = 0/37) in the No-PHTQ group. Amputation rates were higher in PHTQ than No-PHTQ with similar ISS and AIS ( = .96, = .59). The incidence of nerve palsy and compartment syndrome was not different ( > .05).
This study showed a significant amount of prehospital tourniquets are being placed on patients without vascular injuries. Further studies are needed to elucidate the appropriateness of prehospital tourniquets, including targeted education of tourniquet placement.
战场上对四肢创伤使用止血带，导致民用现场前使用止血带的情况增加。研究表明，适当的现场前止血带应用可以降低到达休克的发生率，而不会增加肢体并发症。本研究旨在检查无明确血管损伤的现场前止血带放置的结果。
通过美国创伤外科学会从 29 个创伤中心前瞻性维护的数据库进行回顾性分析。本亚组分析中的患者没有通过影像学或术中确定的重大血管损伤。将接受现场前止血带（PHTQ）的患者与未接受现场前止血带（No-PHTQ）的患者进行比较。结果为截肢率、神经麻痹、筋膜间室综合征和院内死亡率。
共有 622 例患者无重大血管损伤。在 PHTQ 组中，无重大血管损伤患者的发生率更高（n = 585/962，60.8% vs n = 37/88，42.0%，<.001）。两组在年龄、性别、穿透机制、损伤严重程度评分（ISS）、简明损伤评分（AIS）和死亡率方面相似（>.05）。PHTQ 组的截肢率为 8.3%（n = 49/585），而 No-PHTQ 组为 0%（n = 0/37）。在 PHTQ 组中，截肢率高于 No-PHTQ，且 ISS 和 AIS 相似（=.96，=.59）。神经麻痹和筋膜间室综合征的发生率无差异（>.05）。
本研究表明，大量现场前止血带被放置在无血管损伤的患者身上。需要进一步研究阐明现场前止血带的适当性，包括止血带放置的针对性教育。
