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Vascular imaging immediately after tourniquet removal does not increase vasospasm risk
Eric H Mace1, Amelia W Maiga2, Robel T Beyene2
1Vanderbilt University Medical Center, Department of General Surgery, Nashville, Tennessee, Medical Center North, D-5203, Suite CCC-4312, 1161 21st Avenue South, Nashville, TN 37232-2730, USA.
Injury
|August 10, 2023
Summary
Tourniquet use in trauma patients can cause vasospasm, leading to false positives on CT angiography. Study found no link between tourniquet time and imaging accuracy, supporting prompt trauma care.
Area of Science:
- Trauma Surgery
- Vascular Imaging
- Emergency Medicine
Background:
- Prehospital tourniquet use is standard for extremity vascular injuries.
- Tourniquet-associated vasospasm may cause false positives on CT angiography (CTA).
- This phenomenon can complicate the assessment of true arterial injuries.
Purpose of the Study:
- To investigate the correlation between tourniquet application duration, time to CTA imaging, and false positive CTA findings.
- To determine if vasospasm on CTA is influenced by tourniquet removal interval or duration.
- To inform trauma patient management protocols regarding imaging after tourniquet use.
Main Methods:
- Retrospective cohort study of 251 trauma patients with prehospital tourniquets (2019-2021).
- Analysis of tourniquet duration, time from removal to CTA (CTA interval), and CTA findings.
- Multivariable logistic regression used to assess associations with false positive CTA injuries.
Main Results:
- Of 127 patients who underwent CTA, 57 (45%) had false positive arterial injuries.
- Neither CTA interval nor tourniquet duration correlated with false positive CTA.
- Female sex was associated with false positives (OR 2.91); vasospasm cited in 40% of false positive reports.
Conclusions:
- Arterial vasospasm is common on CTA post-tourniquet use but should not alter trauma management.
- Tourniquet duration and time to CTA do not impact imaging accuracy or vasospasm likelihood.
- Findings support expedited imaging and care for severe extremity trauma patients.
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