title: Tourniquet use for civilian extremity trauma.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors.affiliation: From the Department of Surgery, University of Southern California, Los Angeles, California.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Stefano
authors.initials: S
authors.lastname: Siboni
authors.forename: Shelby
authors.initials: S
authors.lastname: Resnick
authors.forename: Jay
authors.initials: J
authors.lastname: Zhu
authors.forename: Monica Darlene
authors.initials: MD
authors.lastname: Wong
authors.forename: Tobias
authors.initials: T
authors.lastname: Haltmeier
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods*; D005121:Extremities / Q000098:blood supply* / Q000293:injuries*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014111:Tourniquets; D057772:Vascular System Injuries / Q000150:complications / Q000628:therapy*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy; D055815:Young Adult