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Systematic review of prehospital tourniquet use in civilian limb trauma

Kauvar, David S. MD; Dubick, Michael A. PhD; Walters, Thomas J. PhD; Kragh, John F. Jr. MD

Journal of Trauma and Acute Care Surgery: May 2018 - Volume 84 - Issue 5 - p 819–825
doi: 10.1097/TA.0000000000001826
Systematic Reviews
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BACKGROUND Military enthusiasm for limb tourniquet use in combat casualty care has resulted in acceptance by the trauma community for use in the prehospital care of civilian limb injuries. To date, there has been no report synthesizing the published data on civilian tourniquet use. The objective of this systematic review was to compile and analyze the content and quality of published data on the civilian use of tourniquets in limb trauma.

METHODS The MEDLINE database was searched for studies on civilian limb tourniquet use in adults published between 2001 and 2017. Search terms were tourniquet, trauma, and injury. Military reports and case series lacking systematic data collection were excluded. Counts and percentages were aggregated and weighted for analysis.

RESULTS Reports were included from six regional trauma centers and one interregional collaboration (total of 572 cases). One national prehospital database report was included but analyzed separately (2,048 cases). All were retrospective cohort studies without prospective data collection. Three reports defined a primary outcome, two had a nontourniquet control group, and no two articles reported the same variables. Limb injury severity and characteristics were inconsistently and incompletely described across reports, as were tourniquet indications and effectiveness. Arterial injury was reported in two studies and was infrequent among cases of tourniquet use. Mortality was low, and limb-specific complications were infrequent but variably reported.

CONCLUSION The rapid increase in the civilian use of tourniquets for limb hemorrhage control has occurred without a large amount or high quality of data. Adoption of a multicenter registry with standardized data collection specific to limb trauma and tourniquet use can serve to improve the trauma community's understanding of the safety and effectiveness of tourniquet use in civilian trauma settings.

LEVEL OF EVIDENCE Systematic review, level IV.

From the Vascular Surgery Service, San Antonio Military Medical Center (D.S.K.), Fort Sam Houston, Texas; Department of Surgery (D.S.K., J.F.K.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; and United States Army Institute of Surgical Research (M.A.D., T.J.W., J.F.K.), Fort Sam Houston, Texas.

Submitted: November 28, 2017, Revised: January 11, 2018, Accepted: January 22, 2018, Published online: February 9, 2018.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jtrauma.com).

Address for reprints: David S. Kauvar, MD, Vascular Surgery Service, San Antonio Military Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234; email: davekauvar@gmail.com.

© 2018 Lippincott Williams & Wilkins, Inc.