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Transfusion for shock in US military war casualties with and without tourniquet use.
Kragh, John F; Nam, Jason J; Berry, Keith A; Mase, Vincent J; Aden, James K; Walters, Thomas J; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H.
Afiliação
  • Kragh JF; Damage Control Resuscitation; Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD. Electronic address: john.f.kragh.civ@mail.mil.
  • Nam JJ; Walter Reed National Military Medical Center, Bethesda, MD.
  • Berry KA; Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA.
  • Mase VJ; Brian Allgood Army Community Hospital, Seoul, South Korea.
  • Aden JK; US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
  • Walters TJ; US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
  • Dubick MA; Damage Control Resuscitation.
  • Baer DG; US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
  • Wade CE; University of Texas Medical School at Houston, Houston, TX.
  • Blackbourne LH; San Antonio Military Medical Center, JBSA Fort Sam, Houston, TX.
Ann Emerg Med ; 65(3): 290-6, 2015 Mar.
Article em En | MEDLINE | ID: mdl-25458979
STUDY OBJECTIVE: We assess whether emergency tourniquet use for transfused war casualties admitted to military hospitals is associated with survival. METHODS: A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and tourniquet use were compared with similar patients who did not receive tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by tourniquet-use status. Additionally, direct comparison without propensity matching was made between tourniquet use and no-tourniquet use groups. RESULTS: There were 720 casualties in the tourniquet use and 693 in the no-tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval -2.5% to 4.2%), but casualties who received tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval -6.7% to 2.7%) between the 2 groups. CONCLUSION: Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive tourniquets.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque / Torniquetes / Ferimentos e Lesões / Transfusão de Sangue Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2015 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque / Torniquetes / Ferimentos e Lesões / Transfusão de Sangue Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2015 Tipo de documento: Article