The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock

Scerbo, Michelle H.; Holcomb, John B.; Taub, Ethan; Gates, Keith; Love, Joseph D.; Wade, Charles E.; Cotton, Bryan A.

doi:10.1097/ta.0000000000001666

Cited by 106 publications

(106 citation statements)

References 30 publications

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“…Endovascular treatment of blunt thoracic aortic injury is now widely accepted [14], although its role in penetrating injuries to the chest [15] and blunt or penetrating injury to the abdominal aorta are unclear [16]. In much the same way that increased prehospital tourniquet use has improved outcomes in patients with extremity hemorrhage [3,5,6], effective prehospital control of non-compressible torso hemorrhage could save many lives [17]. Thus, one impetus for the current study is to generate data to inform the development of techniques for control of non-compressible torso hemorrhage that can be used in the pre-operating room phase of care (including the prehospital phase, ED, and non-trauma centers).…”

Section: Discussionmentioning

confidence: 99%

“…For example, Eastridge et al, reported decreased exsanguination rate due to peripheral hemorrhage by 85% (from 23.3 to 3.5 deaths per year) after implementation of increased military tourniquet use that resulted from a review of military autopsy data [3]. Translation of tourniquet use to the civilian sector in the form of the Stop the Bleed Campaign has also yielded positive results [5,6]. Recently, Drake et al conducted a retrospective review of all death-related (including prehospital and hospital medical examiner) records that occurred during 2014 in Harris County, Texas and determined the preventable and potentially preventable trauma death rate to be 36% [7].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

Chang

Drake

Holcomb

et al. 2020

JCM

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Background: The National Academies of Science have issued a call for zero preventable trauma deaths. The mortality characteristics in all patients with aortic injury are not well described. Methods: All prehospital and hospital medical examiner records for deaths occurring in Harris County, Texas in 2014 were retrospectively reviewed, and patients with traumatic aortic injury were selected. The level of aortic injury was categorized by zone (0 through 9) and further grouped by aortic region (arch, zones 0 to 2; descending thoracic, zones 3 to 5; visceral abdominal, zones 6 to 8; infrarenal, zone 9). Multiple investigators used standardized criteria to categorize deaths as preventable, potentially preventable, or non-preventable. Results: Of 1848 trauma deaths, 192 (10%) had aortic injury. There were 59 (31%) aortic arch, 144 (75%) descending thoracic, 19 (10%) visceral abdominal, and 20 (10%) infrarenal aortic injuries. There were 178 (93%) non-preventable deaths and 14 (7%) potentially preventable deaths, and none were preventable. Non-preventable deaths were associated with blunt trauma (69%) and the arch or thoracic aorta (93%), whereas potentially preventable deaths were associated with penetrating trauma (93%) and the visceral abdominal or infrarenal aorta (79%) (all p < 0.05). Half of potentially preventable deaths (n = 7) occurred at the scene, and half occurred at a trauma center. Conclusion: Potentially preventable deaths after aortic injury were associated with penetrating mechanism and injury to the visceral abdominal and/or infrarenal aorta. Optimal prehospital and ED treatment include temporizing hemorrhage control, hemostatic resuscitation, and faster transport to definitive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

Chang

Drake

Holcomb

et al. 2020

JCM

Self Cite

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“…Internationally and historically, stopping life-threatening bleeding (LTB) is a core competency for first aid providers to surgeons. Although there are many causes for LTB, from road traffic accidents to acts of violence, the epidemiology of death from LTB suggests that a point-of-injury approach to stopping LTB must be improved [1][2][3][4][5][6][7][8]. In the United States the Stop the Bleed (STB) campaign launched in 2015 [9] to translate lifesaving military medical lessons learned from point-of-injury hemorrhage control to benefit the public through awareness and skill education [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“Stop the Bleed” Education Assessment Tool (SBEAT): Development and Validation

Pellegrino

Charlton

Goolsby

2020

Cureus

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As part of the national Stop the Bleed campaign in the United States, more than a million people have received bleeding control training through the work of many organizations. These public and professional educational experiences are ideally grounded in health sciences, clinical, and educational evidence to be most effective. However, there is currently no standard tool for evaluating the educational quality of these programs. We developed and validated the Stop the Bleed Education Assessment Tool (SBEAT) to provide a standard measure of lifethreatening bleeding educational programs knowledge learning outcomes to aid in evaluation and development of this public health program. The SBEAT development included medical, clinical, and educational experts to derive and validate learning outcomes. Specific item writing incorporated focus groups for input on language and then pilot testing before a full community pilot test established a data set, for which a Rasch methodology was applied. The resulting tool used 34 items embedded in 19 survey questions, with item separation statistic of 5.56 (0.97 reliability) and person separation statistic of 2.09 (0.81 reliability) for 171 persons. Overall, the Cronbach Alpha (KR-20) person score "test reliability" equaled 0.85 (SEM = 2.24). The SBEAT project establishes a standardized assessment tool to evaluate the cognitive aspects of first aid for life threatening bleeding. Comparison of outcomes from different teaching styles and methods will allow for the development of best practices for future bleeding control education and help organizations demonstrate value to learners, funders, and policy makers, and advance health sciences education. SBEAT offers a measure for which educational efficiency and efficacy can be judged within a larger effort to prepare people for personal emergencies or large-scale disasters.

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“…Hemorrhagic shock could be a result of severe lower extremity trauma due to femoral artery injuries, severe multiple fractures, and a wide range of degloving injuries [1]. Although tourniquets may be effective to control of hemorrhage in many injuries, they may not be effective to achieve hemostasis in patients with severe injuries which extend proximally to the inguinal region [2], [3].…”

Section: Introductionmentioning

confidence: 99%

The utility of resuscitative endovascular balloon occlusion of the aorta for temporary hemostasis after extensive bilateral lower extremity injuries: A case report

Shinjo

Izawa

Watanabe

et al. 2019

Radiology Case Reports

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A 75-year-old pedestrian was struck by a truck and in shock with both lower extremities significantly deformed, with injuries extending proximally to the inguinal region and degloving injuries. Resuscitative endovascular balloon occlusion of the aorta was performed to achieve temporary hemostasis and the patient became hemodynamically stable. Following stabilization, both lower extremities were amputated. Resuscitative endovascular balloon occlusion of the aorta may be effective to achieve temporary hemostasis in patients with extensive injuries of the lower extremities, especially with extension to the inguinal region which precludes use of a tourniquet.

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The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock

Abstract: Level IV.

Cited by 106 publications

References 30 publications

Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

“Stop the Bleed” Education Assessment Tool (SBEAT): Development and Validation

The utility of resuscitative endovascular balloon occlusion of the aorta for temporary hemostasis after extensive bilateral lower extremity injuries: A case report

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