2009/09/01 by Jon Clasper, J Clasper, K L Brown +2 · 47 citations
Medicine · #Bone fractures and treatments #Medicine #Surgery #Surgical Sutures and Adhesives #Tourniquet #Trauma, Hemostasis, Coagulopathy, Resuscitation
paper · doi:10.1136/jramc-155-03-06
published in Journal of the Royal Army Medical Corps 155(3), 200-202 (BMJ)
crossref issued 2009/09/01 · crossref published 2009/09/01 · crossref published-online 2009/09/01 · crossref published-print 2009/09/01 · openalex publication_date 2009/09/01 · crossref created 2013/03/19 · crossref deposited 2024/05/20 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/02 · crossref indexed 2026/08/02
It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19/22 patients had a least one complication compared to 15/22 where no tourniquet had been applied [p = 0.13]. There were 10 limbs with at least one major complication in the pre-hospital tourniquet group but only four in the group with no tourniquet [p = 0.045]. The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p < 0.05, suggests the use of a pre-hospital tourniquet as a factor. Although the use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk/benefit ratio remains.