268 The Comparative Effectiveness of Three Junctional Tourniquet Devices in Human Volunteers

Abstract

of door-to-imaging. We chose door-to-imaging time because it is an objective measure of adherence to the American Heart Association Get With The Guidelines program and is primarily under the control of ED work environment and personnel.Methods: This was a retrospective analysis of prospectively collected registry data for all patients who presented to the ED of our urban, academic, regional stroke center between June 15, 2014 and June 14, 2015 for whom the stroke team was activated. Trained abstractors reviewed the medical record for each patient in the registry to validate the registry data. Our primary outcome was the binary variable of arrival-to-CT complete time (ie, images available) within 25 minutes. We considered a number of candidate predictors including age, sex, arrival hour of day, day of week, month, year, initial vital signs, initial glucose, initial Glasgow Coma Scale, mental status, National Institutes of Health Stroke Scale, time since symptom onset, prior documented stroke/TIA, diabetes, or hypertension, arrival mode, triage Emergency Severity Index (ESI) score, and whether the care was initiated in a resuscitation room. We fit a multivariate logistic regression model using stepwise backward elimination to minimize the Bayesian information criterion with maximum likelihood estimation. Odds ratios and 95% confidence intervals were calculated using exponentiation from the regression parameter estimates.Results: Of 490 registry patients, 27 were excluded due to delays in imaging due to emergent conditions other than acute stroke, most commonly airway management. Of the included patients, 207 (45%) had a final ED diagnosis of stroke or intracranial hemorrhage, 303 (65%) were admitted to neurology or neurocritical care, and 46 (9.9%) received thrombolytics or a neurointerventional procedure. Variables found to be significant in the final regression model are listed in Table 1 with multivariate odds ratios for arrival-to-CT within 25 minutes. Overall, the regression model performed well (area under the curve of 0.90).Conclusion: Of the variables considered, female sex was associated with the lowest odds ratio of timely door-to-imaging in acute stroke. It was also the only predictor not related to care process or vital signs. Prior literature is conflicting; however, these results provide evidence that sex may impact initial management of stroke patients more than currently recognized, warranting further prospective investigation.

Results of combat medic junctional tourniquet training: a prospective, single-blind, randomized, cross-over study

“…Our observation is supported by Gaspary et al’s conference abstract, which reported 43% success rates of SJT ® on litter-carried patients. [ 24 ]…”