title: Transfusion for shock in US military war casualties with and without tourniquet use.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Damage Control Resuscitation; Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD. Electronic address: john.f.kragh.civ@mail.mil.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Nam
authors.affiliation: Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Berry
authors.affiliation: Brian Allgood Army Community Hospital, Seoul, South Korea.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Mase
authors.affiliation: US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walters
authors.affiliation: Damage Control Resuscitation.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.affiliation: US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
authors.affiliation: University of Texas Medical School at Houston, Houston, TX.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: San Antonio Military Medical Center, JBSA Fort Sam, Houston, TX.
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D055826:Afghan Campaign 2001-; D001803:Blood Transfusion; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000379:methods; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D014111:Tourniquets / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy; D055815:Young Adult