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%; P = 1.0). Matched comparison of patients with vascular injury showed similar mortality for PHT vs non-PHT (3.7% vs 3.7%, P = 1.00). The same was true for isolated extremity trauma (4.1% vs 0.0%, P = 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.