Academic Journal
Προβολή σε EDS
Συνδεδεμένο Πλήρες Κείμενο

Association between prehospital tourniquet application and post-traumatic stress disorder in military personnel: A retrospective cohort study.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Association between prehospital tourniquet application and post-traumatic stress disorder in military personnel: A retrospective cohort study.
Συγγραφείς: Fridrich L; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (L.F.); Department of Surgery, Meir Medical Center, affiliated with Tel Aviv University, Israel ((L.F.); Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, Israel (T.T., Z.A.B., A.B.); Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel (T.T., Z.A.B.); Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel (T.T., Y.R.); The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel (T.T.,I.R.); Critical Care Surgery and Trauma Unit, Sheba Medical Center, Tel-HaShomer, Israel (Y.K.); and The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (A.B.)., Talmy T, Rudnicki Y, Radomislenski I, Aviad Beer Z, Klein Y, Benov A
Συλλογικό Έργο: Israel Trauma Group, Ramat Gan, Israel, Israel Trauma Group, and Ramat Gan, Israel
Πηγή: The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2026 Aug 01; Vol. 101 (2 Suppl 2026), pp. S106-S113. Date of Electronic Publication: 2026 Jun 04.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE
Imprint Name(s): Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins
Ιατρικοί όροι (MeSH): Tourniquets*/adverse effects , Tourniquets*/statistics & numerical data , Stress Disorders, Post-Traumatic*/epidemiology , Stress Disorders, Post-Traumatic*/etiology , Military Personnel*/psychology , Military Personnel*/statistics & numerical data , Hemorrhage*/therapy, Registries/statistics & numerical data ; United States/epidemiology ; Humans ; Retrospective Studies ; Male ; Female ; Adult ; Injury Severity Score ; Emergency Medical Services ; Young Adult
Περίληψη: Background: Post-traumatic stress disorder (PTSD) is a well-documented consequence of combat-related trauma. While tourniquet application is a cornerstone of hemorrhage control in military settings, its mental health consequences have not been explored. We aimed to assess the association between prehospital tourniquet application and subsequent PTSD among military personnel with extremity injuries.
Methods: In this retrospective cohort study, we utilized linked military and national trauma registries to identify military personnel with extremity injuries and Injury Severity Score (ISS) ≤8 between 2006 and 2021. Participants were grouped based on documented prehospital use of tourniquets. Service-connected PTSD diagnoses were retrieved from the Ministry of Defense Rehabilitation Department disability claim records and validated by the PTSD Checklist for DSM-5 (PCL-5). Logistic regression models were used to assess associations between tourniquet use and PTSD, adjusting for confounders including injury mechanism, event type, head injury, number of injured persons, and hospitalization status.
Results: During 31,690 person-years of follow-up, a total of 2,876 military personnel met the inclusion criteria, of whom 123 (4.3%) received a tourniquet. PTSD was diagnosed in 244 (8.5%) of all casualties, with a prevalence of 30.9% (n=38) among those who received a tourniquet, compared with 7.5% (n=206) among those who did not ( p <0.0001). In unadjusted analyses, tourniquet use was strongly associated with increased odds of PTSD (odds ratio, 5.53; 95% confidence interval, 3.64-8.26). After adjusting for confounders, tourniquet use remained significantly associated with PTSD (odds ratio, 1.70; 95% confidence interval, 1.07-2.66).
Conclusions: Tourniquet use was associated with increased odds of PTSD, even after accounting for key confounders. While essential for hemorrhage control, this association should be interpreted with caution, as it may reflect underlying injury context, operational intensity, or other unmeasured confounders rather than a direct causal effect. Tourniquet use was associated with increased odds of PTSD; however, this association should not be interpreted as causal and does not support changes to current point-of-injury tourniquet guidelines. Rather, it may reflect underlying injury context, operational intensity, or other unmeasured confounders. ( J Trauma Acute Care Surg . 2026;101: S106-S113. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).
Level of Evidence: Prognostic/epidemiological, Level III.
(Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)
References: Copeland LA, Zeber JE, Bingham MO, Pugh MJ, Noël PH, Schmacker ER, et al. Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded. J Affect Disord. 2011;130(1–2):226–230.
Giordano NA, Bader C, Richmond TS, Polomano RC. Complexity of the relationships of pain, posttraumatic stress, and depression in combat-injured populations: an integrative review to inform evidence-based practice. Worldviews Evid Based Nur. 2018;15:113–126.
Tortella-Feliu M, Fullana MA, Pérez-Vigil A, Torres X, Chamorro J, Littarelli SA, et al. Risk factors for posttraumatic stress disorder: an umbrella review of systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2019;107:154–165.
Sayed S, Iacoviello BM, Charney DS. Risk factors for the development of psychopathology following trauma. Curr Psychiatry Rep. 2015;17(8):70.
Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: a TRACK-TBI study. JAMA Psychiatry. 2019;76(3):249.
Shalev A, Liberzon I, Marmar C. Post-traumatic stress disorder. N Engl J Med. 2017;376(25):2459–2469.
Iversen AC, Fear NT, Ehlers A, Hacker Hughes J, Hull L, Earnshaw M, et al. Risk factors for post-traumatic stress disorder among UK Armed Forces personnel. Psychol Med. 2008;38(4):511–522.
MacGregor AJ, Tang JJ, Dougherty AL, Galarneau MR. Deployment-related injury and posttraumatic stress disorder in US military personnel. Injury. 2013;44(11):1458–1464.
Forbes HJ, Jones N, Woodhead C, Greenberg N, Harrison K, White S, et al. What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK Army personnel who have served in Iraq or Afghanistan. BMC Psychiatry. 2012;12:178.
Phillips CJ, LeardMann CA, Gumbs GR, Smith B. Risk factors for posttraumatic stress disorder among deployed US male marines. BMC Psychiatry. 2010;10:52.
Schroll R, Smith A, Alabaster K, Schroeppel TJ, Stillman ZE, Teicher EJ, et al. AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma. J Trauma Acute Care Surg. 2022;92(6):997–1004.
Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl. 5):431–437.
Tsur AM, Nadler R, Lipsky AM, Levi D, Bader T, Benov A, et al. The Israel Defense Forces Trauma Registry: 22 years of point-of-injury data. J Trauma Acute Care Surg. 2020;89(2S Suppl 2):S32–S38.
Iversen AC, Fear NT, Ehlers A, Hacker Hughes J, Hull L, Earnshaw M, et al. Risk factors for post traumatic stress disorder amongst United Kingdom Armed Forces personnel. Psychol Med. 2008;38(4):511–522.
Xue C, Ge Y, Tang B, Liu Y, Kang P, Wang M, et al. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One. 2015;10(3):0120270.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349.
Tsur AM, Nadler R, Benov A, Glassberg E, Siman-Tov M, Radomislensky I, et al. The effects of military-wide introduction of advanced tourniquets in the Israel Defense Forces. Injury. 2020;51:1210–1215.
Kaim A, Bodas M, Bieler D, Radomislensky I, Matthes G, Givon A, et al. Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison. Front Public Health 2023;11:2–11.
Prat D, Braun M, Givon A, Goldman S, Katorza E, Shapira S. How do gunshot and explosive injuries to the lower extremities differ in severity and treatment? A Comparative study from the Israel-Gaza Conflict. Clin Orthop Relat Res. 2025;483:2037–2043.
Bulis S, Talmy T, Radomislensky I, Gelman D, Bushinsky S, Nachum D, et al. The association between Glasgow Coma Scale Scores and PTSD in military trauma casualties: does mental status following injury play a role in PTSD development? Mil Med. 2023;188:428–435.
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–498.
Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, et al. Characteristics and impact of U.S. military blast-related mild traumatic brain injury: a systematic review. Front Neurol. 2020;11.
Talmy T, Bulis S, Radomislensky I, Bushinsky S, Tsur N, Gelman D, et al. Association between the number of individuals injured in a traumatic event and posttraumatic stress disorder among hospitalized trauma patients. J Trauma Stress. 2024;38(1):135–145.
Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, et al. Died of wounds on the battlefield: causation and implications for improving combat casualty care. J Trauma. 2011;71(Suppl. 1):S4–S8.
Baruch NE, Avi B, Ram S, Elon G, Roy N, Sami G, et al. Point of injury medical care during the “Protective Edge” battle. J Isr Mil Med. 2015;12:7–12.
Kragh JF, Littrel ML, Jones JA, Walters TJ, Baer DG, Wade CE, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–597.
Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. J Trauma. 2008;64(2 Suppl):21–27.
Kragh JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249(1):1–7.
Stevens RA, Baker MS, Zubach OB, Samotowka M. Misuse of tourniquets in Ukraine may be costing more lives and limbs than they save. Mil Med. 2024;189:304–308.
Butler F, Holcomb JB, Dorlac W, Gurney J, Inaba K, Jacobs L, et al. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. J Trauma Acute Care Surg. 2024;97(2):S45–S54.
de Souza Leão MG, Neta GPM, Coutinho LI, da Silva TM, Ferreira YMC, Dias WRV. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure. Rev Bras Ortop (English Edition). 2016;51(6):672–679.
Holcomb JB, Dorlac WC, Drew BG, Butler FK, Gurney JM, Montgomery HR, et al. Rethinking limb tourniquet conversion in the prehospital environment. J Trauma Acute Care Surg. 2023;95(6):e54–e60.
Contributed Indexing: Investigator: H Bahouth; A Bar; A Braslavsky; D Czeiger; D Fadeev; AL Goldstein; I Grevtsev; G Hirschhorn; I Jeroukhimov; A Kedar; Y Klein; A Korin; B Levit; I Schrier; AD Schwarz; W Shomar; D Soffer; M Weiss; O Yaslowitz; I Zoarets
Keywords: Trauma; battlefield; post-traumatic stress disorder; tourniquets
Entry Date(s): Date Created: 20260604 Date Completed: 20260730 Latest Revision: 20260730
Update Code: 20260730
PubMed Central ID: PMC13412364
DOI: 10.1097/TA.0000000000005081
PMID: 42240281
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:2163-0763
DOI:10.1097/TA.0000000000005081