{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T20:36:41Z","timestamp":1769200601638,"version":"3.49.0"},"reference-count":15,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2019,1,3]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Timely tourniquet placement may limit ongoing hemorrhage and reduce the need for blood products. This study evaluates if prehospital tourniquet application altered the initial transfusion needs in arterial injuries when compared with a non-tourniquet control group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Extremity arterial injuries were queried from our level I trauma center registry from 2013 to 2017. The characteristics of the cohort with prehospital tourniquet placement (TQ+) were described in terms of tourniquet use, duration, and frequency over time. These cases were matched 1:1 by the artery injured, demographics, Injury Severity Score, and mechanism of injury to patients arriving without a tourniquet (TQ\u2212). The primary outcome was transfusion within the first 24 hours, with secondary outcomes of morbidity (rhabdomyolysis, renal failure, compartment syndrome), amputation (initial vs. delayed), and length of stay. Statistical tests included t-test and \u03c7<jats:sup>2<\/jats:sup> for continuous and categorical variables, respectively, with p&lt;0.05 considered as significant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Extremity arterial injuries occurred in 192 patients, with 69 (36%) having prehospital tourniquet placement for an average of 78 minutes. Tourniquet use increased over time from 9% (2013) to 62% (2017). TQ+ patients were predominantly male (81%), with a mean age of 35.0 years. Forty-six (67%) received blood transfusion within the first 24 hours. In the matched comparison (n=69 pairs), TQ+ patients had higher initial heart rate (110 vs. 100, p=0.02), frequency of transfusion (67% vs. 48%, p&lt;0.01), and initial amputations (23% vs. 6%, p&lt;0.01). TQ+ patients had increased frequency of initial amputation regardless of upper (n=43 pairs) versus lower (n=26 pairs) extremity involvement; however, only upper extremity TQ+ patients had increased transfusion frequency and volume. No difference was observed in morbidity, length of stay, and mortality with tourniquet use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Tourniquet use has increased over time in patients with extremity arterial injuries. Patients having prehospital tourniquets required a higher frequency of transfusion and initial amputation, without an increase in complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Therapeutic study, level IV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2018-000267","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T06:29:38Z","timestamp":1548397778000},"page":"e000267","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Effect of prehospital tourniquets on resuscitation in extremity arterial trauma"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-8440","authenticated-orcid":false,"given":"Allison G","family":"McNickle","sequence":"first","affiliation":[{"name":"Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas R","family":"Fraser","sequence":"additional","affiliation":[{"name":"Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J","family":"Chestovich","sequence":"additional","affiliation":[{"name":"Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA"},{"name":"Surgery, University of Nevada, Las Vegas, Las Vegas, Nevada, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah A","family":"Kuhls","sequence":"additional","affiliation":[{"name":"Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J","family":"Fildes","sequence":"additional","affiliation":[{"name":"Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"2025082410484024000_4.1.e000267.1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.964892"},{"key":"2025082410484024000_4.1.e000267.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.10.021"},{"key":"2025082410484024000_4.1.e000267.3","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1080\/10903127.2016.1182606","article-title":"Safety and appropriateness of tourniquets in 105 civilians","volume":"20","author":"Scerbo","year":"2016","journal-title":"Prehosp Emerg Care"},{"key":"2025082410484024000_4.1.e000267.4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/TA.0000000000001115","article-title":"A multi-institutional study of hemostatic gauze and tourniquets in rural civilian trauma","volume":"81","author":"Leonard","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410484024000_4.1.e000267.5","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000689"},{"key":"2025082410484024000_4.1.e000267.6","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.896962"},{"key":"2025082410484024000_4.1.e000267.7","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1097\/TA.0b013e318296b237","article-title":"Improving survival from active shooter events: the Hartford consensus","volume":"74","author":"Jacobs","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410484024000_4.1.e000267.8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1080\/10903127.2016.1227002","article-title":"Trends and predictors of limb tourniquet use by civilian emergency medical services in the United States","volume":"21","author":"El Sayed","year":"2017","journal-title":"Prehosp Emerg Care"},{"key":"2025082410484024000_4.1.e000267.9","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/TA.0000000000001826","article-title":"Systematic review of prehospital tourniquet use in civilian limb trauma","volume":"84","author":"Kauvar","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410484024000_4.1.e000267.10","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/TA.0000000000000988","article-title":"The state of the Union: nationwide absence of uniform guidelines for the prehospital use of tourniquets to control extremity exsanguination","volume":"80","author":"Ramly","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410484024000_4.1.e000267.11","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000815"},{"key":"2025082410484024000_4.1.e000267.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2013.11.031"},{"key":"2025082410484024000_4.1.e000267.13","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000747"},{"key":"2025082410484024000_4.1.e000267.14","doi-asserted-by":"crossref","unstructured":"Smith AA , Ochoa JE , Wong S . Prehospital tourniquet use in penetrating extremity trauma: decreased blood transfusions and limb complications. J Trauma Acute Care Surg 2018.","DOI":"10.1097\/TA.0000000000002095"},{"key":"2025082410484024000_4.1.e000267.15","doi-asserted-by":"crossref","first-page":"817","DOI":"10.7205\/MILMED-D-10-00417","article-title":"Minor morbidity with emergency tourniquet use to stop bleeding in severe limb trauma: research, history, and reconciling advocates and abolitionists","volume":"176","author":"Kragh","year":"2011","journal-title":"Mil Med"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2018-000267","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:48:49Z","timestamp":1756057729000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2018-000267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,24]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/tsaco-2018-000267"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2018-000267","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}