An Analysis of Junctional Tourniquet Use Within the Department of Defense Trauma Registry.

Abstract

Background: Junctional hemorrhage is a leading cause of battlefield death. Multiple FDA-approved junctional tourniquet (JTQ) models demonstrate effective hemorrhage control in laboratory settings. However, there are few real-world use cases within the literature.

Methods: We analyzed the Department of Defense Trauma Registry (DoDTR) for casualties with documented JTQ application (2007-2023).

Results: Of 48,301 encounters, 39 included JTQ placement. The most common injury mechanisms were explosives (23), followed by firearms (15). The most common (AIS >3) serious injury sites were the extremities (21), followed by the abdomen (4) and skin (4). Only one patient died. Of nine prehospital interventions, the most common were warming (21), limb tourniquet application (16), and intravenous fluid administration (11). The most common associated diagnoses were lower-extremity amputation (24), testis avulsion or amputation (11), pelvic fracture (9), and tympanic membrane rupture (9). The most common hospital procedures were a focused assessment with sonography in trauma (32), laparotomy (20), chest tube placement (13), fasciotomy (13), and arterial line placement (13).

Conclusion: JTQ application in the combat setting was rare. When it was performed, it was frequently in the polytrauma setting. Survival was high but DoDTR enrollment survival biases likely confounded this.