Document Detail

Transfusion for Shock in US Military War Casualties With and Without Tourniquet Use.
MedLine Citation:
PMID:  25458979     Owner:  NLM     Status:  Publisher    
STUDY OBJECTIVE: We assess whether emergency tourniquet use for transfused war casualties admitted to military hospitals is associated with survival.
METHODS: A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and tourniquet use were compared with similar patients who did not receive tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by tourniquet-use status. Additionally, direct comparison without propensity matching was made between tourniquet use and no tourniquet use groups.
RESULTS: There were 720 casualties in the tourniquet use and 693 in the no-tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval -2.5% to 4.2%), but casualties who received tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval -6.7% to 2.7%) between the 2 groups.
CONCLUSION: Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive tourniquets.
John F Kragh; Jason J Nam; Keith A Berry; Vincent J Mase; James K Aden; Thomas J Walters; Michael A Dubick; David G Baer; Charles E Wade; Lorne H Blackbourne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-24
Journal Detail:
Title:  Annals of emergency medicine     Volume:  -     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-2     Completed Date:  -     Revised Date:  2014-12-3    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
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