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

Sharven Taghavi¹, John T Simpson^{1

2}, Ayman Ali^{1

2}, Kristen D Nordham^{1

3}, Leah C Tatebe⁴, Elliot R Haut⁵, Christofer Anderson^{1

6}, Nadia Salib⁷, Zoe Maher⁷, Amy J Goldberg⁷, Shariq Raza⁸, Grace Chang⁹, Eman Toraih¹, Michelle Mendiola Pla¹⁰, Scott Ninokawa^{1

11}, Patrick Maluso¹², Jane Keating¹³, Sigrid Burruss¹⁴, Matthew Reeves¹⁴, Lauren E Coleman¹⁵, David V Shatz¹⁵, Anna Goldenberg Sandau¹⁶, Apoorva Bhupathi¹⁶, M Chance Spalding¹⁷, Aimee LaRiccia¹⁷, Emily Bird¹⁸, Matthew R Noorbakhsh¹⁹, James Babowice¹⁹, Marsha C Nelson²⁰, Lewis E Jacobson²¹, Jamie Williams²¹, Thomas Z Hayward 3rd²², Emma Holler²², Mark J Lieser²³, John D Berne²⁴, Dalier R Mederos²⁴, Reza Askari²⁵, Barbara Okafor²⁵, Eric Etchill^{26

27}, Raymond Fang²⁶, Samantha L Roche²⁶, Laura Whittenburg²⁸, Andrew C Bernard²⁸, James M Haan²⁹, Kelly L Lightwine²⁹, Scott H Norwood³⁰, Jason Murry³⁰, Mark A Gamber³¹, Matthew M Carrick³¹, Nikolay Bugaev³², Antony Tatar³², Danielle Tatum¹

Affiliations

¹ Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA.
² Department of Surgery Durham, Duke University School of Medicine, Durham, NC, USA.
³ Department of Surgery Torrance, Harbor-UCLA Medical Center, CA, USA.
⁴ Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁷ Lewis Katz School of Medicine Department of Surgery, Temple University, Philadelphia, PA, USA.
⁸ Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁹ Department of Surgery, Mount Sinai Hospital, Chicago, IL, USA.
¹⁰ Department of Surgery, University of Illinois Chicago College of Medicine, Chicago, IL, USA.
¹¹ San Diego Department of Emergency Medicine, University of California, San Diego, CA, USA.
¹² Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA.
¹³ Department of Surgery, Hartford Hospital, Hartford, CT, USA.
¹⁴ Department of Surgery, Loma Linda University Medical CenterLoma Linda, CA, USA.
¹⁵ School of Medicine, University of California Davis, Sacramento, CA, USA.
¹⁶ Department of Surgery, Cooper Hospital University Medical Center, Camden, NJ, USA.
¹⁷ Department of Surgery, Grant Medical Center, Columbus, OH, USA.
¹⁸ Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
¹⁹ Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
²⁰ Department of Surgery, Cape Fear Valley Health System, Fayetteville, NC, USA.
²¹ Department of Surgery, Ascension Health, Indianapolis, IN, USA.
²² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
²³ Department of Surgery, Research Medical Center, Kansas City, MO, USA.
²⁴ Department of Surgery, Broward Health, Fort Lauderdale, FL, USA.
²⁵ Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
²⁶ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
²⁷ Department of Surgery, University of Colorado, Denver, CO, USA.
²⁸ Department of Surgery, University of Kentucky, Lexington, KY, USA.
²⁹ Department of Surgery, Ascension Via Christi, Wichita, KS, USA.
³⁰ Department of Surgery, University of Texas Tyler Francis, Tyler, TX, USA.
³¹ Department of Surgery, Medical City Plano, Plano, TX, USA.
³² Department of Surgery, Tufts Medical Center, Boston, MA, USA.

PMID: 41105879
DOI: 10.1177/00031348251388954

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

Sharven Taghavi et al. Am Surg. 2025.

. 2025 Oct 17:31348251388954.

doi: 10.1177/00031348251388954. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA.
² Department of Surgery Durham, Duke University School of Medicine, Durham, NC, USA.
³ Department of Surgery Torrance, Harbor-UCLA Medical Center, CA, USA.
⁴ Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁷ Lewis Katz School of Medicine Department of Surgery, Temple University, Philadelphia, PA, USA.
⁸ Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁹ Department of Surgery, Mount Sinai Hospital, Chicago, IL, USA.
¹⁰ Department of Surgery, University of Illinois Chicago College of Medicine, Chicago, IL, USA.
¹¹ San Diego Department of Emergency Medicine, University of California, San Diego, CA, USA.
¹² Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA.
¹³ Department of Surgery, Hartford Hospital, Hartford, CT, USA.
¹⁴ Department of Surgery, Loma Linda University Medical CenterLoma Linda, CA, USA.
¹⁵ School of Medicine, University of California Davis, Sacramento, CA, USA.
¹⁶ Department of Surgery, Cooper Hospital University Medical Center, Camden, NJ, USA.
¹⁷ Department of Surgery, Grant Medical Center, Columbus, OH, USA.
¹⁸ Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
¹⁹ Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
²⁰ Department of Surgery, Cape Fear Valley Health System, Fayetteville, NC, USA.
²¹ Department of Surgery, Ascension Health, Indianapolis, IN, USA.
²² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
²³ Department of Surgery, Research Medical Center, Kansas City, MO, USA.
²⁴ Department of Surgery, Broward Health, Fort Lauderdale, FL, USA.
²⁵ Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
²⁶ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
²⁷ Department of Surgery, University of Colorado, Denver, CO, USA.
²⁸ Department of Surgery, University of Kentucky, Lexington, KY, USA.
²⁹ Department of Surgery, Ascension Via Christi, Wichita, KS, USA.
³⁰ Department of Surgery, University of Texas Tyler Francis, Tyler, TX, USA.
³¹ Department of Surgery, Medical City Plano, Plano, TX, USA.
³² Department of Surgery, Tufts Medical Center, Boston, MA, USA.

PMID: 41105879
DOI: 10.1177/00031348251388954

Abstract

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.

Keywords: EMS; penetrating trauma; prehospital; tourniquet; trauma surgery.

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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

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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

Authors

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Abstract

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