Increasing prehospital tourniquet use attributed to non-indicated use: an 11-year retrospective study

Purpose: The use of prehospital tourniquets (PHTQ) for haemorrhage control in the civilian trauma population has increased over the past decade with some reports documenting the overuse of the device. The aim of this study was to identify the proportion of PHTQ use that is non-indicated and determine how this proportion is changing over time.

Methods: An 11-year retrospective study was performed at a Level-1 Trauma Centre on all trauma patients admitted with a PHTQ. Local PHTQ guidelines were used to define non-indicated use. Collected variables included patient demographics, injury characteristics, tourniquet application characteristics, prehospital data, emergency department data, and clinical outcomes. The primary outcome was non-indicated PHTQ use. The secondary outcome was complications attributed to PHTQ use.

Results: There were 88 PHTQ applications to 88 extremity injuries in 86 patients (n = 86, median (IQR) age 43 (28-57) years, 85% male). PHTQ use was deemed non-indicated in 68 cases (68/88, 77% [95%CI 67-86%]). The proportion of non-indicated PHTQ use increased over the period of the study period (p = 0.03). At least one complication potentially from PHTQ use was seen in 33 patients (33/86, 38%). In patients with prolonged tourniquet time (n = 13), at least one complication from PHTQ use was seen in 11 patients (11/13, 85%).

Conclusion: Over this 11-year period, we identified that the increase in PHTQ use in civilian trauma is from increasing non-indicated use. Given that complications are associated with unnecessary PHTQ use, the adherence to the guidelines needs to be urgently reinforced.