Time To Tighten Up on Prehospital Tourniquets: An EAST Multicenter Trial of Prehospital Procedures in Penetrating Trauma Shows No Benefit With Current Tourniquet Practices for Extremity Trauma in Urban Settings

BackgroundPrehospital tourniquet (PHT) use has become widespread. However, whether it improves outcomes after penetrating proximal extremity trauma in urban settings remains unknown. We hypothesized that PHT improves mortality in this setting.Materials and MethodsThis was a post hoc analysis of a multicenter study of adults (18+ years) with penetrating torso and/or proximal extremity trauma from 25 urban trauma centers. Subjects were allocated via nearest neighbor propensity matching (chest, abdominal, or extremity injury, GSW vs stab, and vascular injuries) to compare similarly-injured PHT and non-PHT patients.ResultsAmong 2352 patients, 117 (4.9%) received PHT. Prehospital tourniquet patients had 22 (18.84%) arterial injuries, 8 (6.8%) venous injuries, and 92 (78.6%) non-vascular injuries. Most PHTs (86, 73.5%) were placed on-scene, and 22 (18.8%) en-route. Admission of systolic blood pressure was not different between PHT and non-PHT patients. Prehospital tourniquet did not impact survival on regression analysis. After propensity matching, 218 patients remained, who were primarily male (n = 182, 83.9%) with median (IQR) age 30 (23-39) years and new injury severity score 9 (3-17). Mortality was similar between PHT and non-PHT groups (6.4% vs 7.3%; <i>P</i> = 1.0). Matched comparison of patients with vascular injury showed similar mortality for PHT vs non-PHT (3.7% vs 3.7%, <i>P</i> = 1.00). The same was true for isolated extremity trauma (4.1% vs 0.0%, <i>P</i> = 0.25).ConclusionsPHT use for urban, penetrating proximal extremity trauma was not associated with decreased mortality or complications. Further research may determine whether modified tourniquet training improves outcomes, or whether immediate transport to a trauma center is more beneficial for these patients.

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Publication Details

Journal
The American Surgeon
Published
2025-10-17
DOI
https://doi.org/10.1177/00031348251388954
Primary Topic
Trauma and Emergency Care Studies
Type
article
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article

Time To Tighten Up on Prehospital Tourniquets: An EAST Multicenter Trial of Prehospital Procedures in Penetrating Trauma Shows No Benefit With Current Tourniquet Practices for Extremity Trauma in Urban Settings

Andrew C. Bernard, James Babowice, Patrick Maluso, John T. Simpson et al.
The American Surgeon
Trauma and Emergency Care Studies
article

Time To Tighten Up on Prehospital Tourniquets: An EAST Multicenter Trial of Prehospital Procedures in Penetrating Trauma Shows No Benefit With Current Tourniquet Practices for Extremity Trauma in Urban Settings

Andrew C. Bernard, James Babowice, Patrick Maluso, John T. Simpson, Danielle Tatum, Eric Etchill, Reza Askari, Barbara U. Okafor, M. Chance Spalding, Jason Murry, Jamie Williams, Emma Holler, Kelly Lightwine, James M. Haan, Antony Tatar, Raymond Fang, Ayman Ali, Lauren Coleman, Apoorva Bhupathi, Marsha C. Nelson, Nikolay Bugaev, Kristen D. Nordham, Samantha L. Roche, Dalier R. Mederos, Sharven Taghavi, Jane Keating, Matthew Reeves, Christofer Anderson, Aimee LaRiccia, Mark J. Lieser, Leah C. Tatebe, Scott Ninokawa, Michelle Mendiola, Eman A. Toraih, Laura Whittenburg, Emily Bird, Elliott Richard Haut, John D. Berne, Lewis E. Jacobson, Grace Chang, Mark Gamber, David V. Shatz, Sigrid Burruss, Anna Goldenberg Sandau, Shariq Raza, Matthew M. Carrick, Matthew R. Noorbakhsh, Zoë Maher, Thomas Z. Hayward, Amy J. Goldberg, Scott H. Norwood, Nadia Salib
article en

Abstract

BackgroundPrehospital tourniquet (PHT) use has become widespread. However, whether it improves outcomes after penetrating proximal extremity trauma in urban settings remains unknown. We hypothesized that PHT improves mortality in this setting.Materials and MethodsThis was a post hoc analysis of a multicenter study of adults (18+ years) with penetrating torso and/or proximal extremity trauma from 25 urban trauma centers. Subjects were allocated via nearest neighbor propensity matching (chest, abdominal, or extremity injury, GSW vs stab, and vascular injuries) to compare similarly-injured PHT and non-PHT patients.ResultsAmong 2352 patients, 117 (4.9%) received PHT. Prehospital tourniquet patients had 22 (18.84%) arterial injuries, 8 (6.8%) venous injuries, and 92 (78.6%) non-vascular injuries. Most PHTs (86, 73.5%) were placed on-scene, and 22 (18.8%) en-route. Admission of systolic blood pressure was not different between PHT and non-PHT patients. Prehospital tourniquet did not impact survival on regression analysis. After propensity matching, 218 patients remained, who were primarily male (n = 182, 83.9%) with median (IQR) age 30 (23-39) years and new injury severity score 9 (3-17). Mortality was similar between PHT and non-PHT groups (6.4% vs 7.3%; <i>P</i> = 1.0). Matched comparison of patients with vascular injury showed similar mortality for PHT vs non-PHT (3.7% vs 3.7%, <i>P</i> = 1.00). The same was true for isolated extremity trauma (4.1% vs 0.0%, <i>P</i> = 0.25).ConclusionsPHT use for urban, penetrating proximal extremity trauma was not associated with decreased mortality or complications. Further research may determine whether modified tourniquet training improves outcomes, or whether immediate transport to a trauma center is more beneficial for these patients.

The American SurgeonVol. 92(4)
Northwestern University (US), Tulane University (US), Brigham and Women's Hospital (US), Grant Medical Center (US), Tufts Medical Center (US), Loma Linda University Medical Center (US), MetroHealth (US), Hartford Hospital (US), Our Lady of the Lake Regional Medical Center (US), Allegheny Health Network (US), Ascension (US), University of Kentucky (US), Johns Hopkins University (US), Illinois College (US), Duke University (US), The University of Texas at Tyler (US), Loma Linda University (US), Johns Hopkins Medicine (US), Cooper University Hospital (US), Temple College (US), UCLA Medical Center (US), University of Colorado System (US), Research Medical Center (US), University Medical Center (US), Cooper Hospital (IN), University of California System (US), Yale University (US), University of California San Diego (US), University of Illinois Chicago (US), Mount Sinai Hospital (US), University Hospital and Clinics (US), Plano Cancer Institute (US), Cape Fear Valley Health System (US), Johns Hopkins Hospital (US), Ascension Via Christi (US), University School (US), MetroHealth Medical Center (US), Broward Health (US), Harbor–UCLA Medical Center (US), Indiana University School of Medicine, Indiana University – Purdue University Indianapolis (US), Indiana University (US), University of Pennsylvania (US), University of California, Davis (US), Temple University (US), University of St. Francis (US), University of Colorado Denver (US)
Openalex Percentile: Top 57%
Trauma and Emergency Care Studies
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