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Tourniquet use for civilian extremity trauma

Inaba, Kenji MD; Siboni, Stefano MD; Resnick, Shelby MD; Zhu, Jay MD; Wong, Monica Darlene MS; Haltmeier, Tobias MD; Benjamin, Elizabeth MD, PhD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: August 2015 - Volume 79 - Issue 2 - p 232–237
doi: 10.1097/TA.0000000000000747
Original Articles

BACKGROUND Unlike in the military setting, where the use of tourniquets has been well established, in the civilian sector their use has been far less uniform. The purpose of this study was to examine the outcomes associated with the use of tourniquets for civilian extremity trauma.

STUDY DESIGN Adult (≥18 years) patients admitted to our institution with an extremity injury requiring tourniquet application from January 2007 to June 2014 were retrospectively reviewed. The primary outcome analyzed was limb loss. Secondary outcomes included death, hospital length of stay, and complications.

RESULTS There were 87 patients who met inclusion criteria. Average age was 35.3 years, 90.8% were male, and 66.7% had penetrating injuries, with a median Injury Severity Score (ISS) of 6. Tourniquets were placed in the prehospital setting in 50.6%, in the emergency department in 39.1%, and in the operating room in 10.3% of patients. The windlass type Combat Application Tourniquet was the most commonly used type (67.8%), followed by a pneumatic system (24.1%) and self-made tourniquet (8.0%). The median duration of use was 75 minutes (interquartile range, 91) with no differences between groups (p = 0.547). Overall, 80.5% had a vascular injury (70.1% arterial), and a total of 99 limb operations were performed, including 15 amputations. Fourteen amputations (93.3%) occurred at the scene or were directly attributed to the extent of tissue damage with a median Mangled Extremity Severity Score (MESS) of 7 (interquartile range, 2). In the remaining patient, the tourniquet was lifesaving but likely contributed to limb loss. Seven patients sustained 13 other complications; however, none was directly attributed to tourniquet use.

CONCLUSION Tourniquet use in the civilian sector is associated with a low rate of complications. With the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified.

LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.

From the Department of Surgery, University of Southern California, Los Angeles, California.

Submitted: November 23, 2014, Revised: April 1, 2015, Accepted: April 3, 2015.

Address for reprints: Kenji Inaba, MD, Division of Trauma and Surgical Critical Care University of Southern California LAC + USC Medical Center, 2051 Marengo St, IPT, C5L100 Los Angeles, CA 90033; email:

© 2015 Lippincott Williams & Wilkins, Inc.