Assessing Evidence Bias for Prehospital Tourniquet Use: A Scoping Review

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Global Health

Background:

• Current evidence on prehospital tourniquet use primarily stems from military experiences in high-resource nations.
• The effectiveness and consequences of tourniquet application vary significantly across different healthcare settings, especially in low-resource environments where treatment and evacuation times are prolonged.
• Global trauma burden disproportionately impacts low- and middle-income countries, yet existing guidelines may not be transferable.

Purpose of the Study:

• To conduct a scoping review of existing literature on prehospital tourniquet use.
• To analyze the geographical and socioeconomic distribution of studies reporting clinical outcomes.
• To identify gaps in research, particularly concerning low-resource settings.

Main Methods:

• A scoping review following PRISMA-ScR guidelines was performed.
• Searches were conducted to identify reports with clinical outcomes on prehospital tourniquet use.
• Two physicians screened titles, abstracts, and full texts, excluding reports without outcome measures.

Main Results:

• 52 reports involving 27,429 patients were included; most originated from high-income countries (USA, Iraq/Afghanistan).
• No included reports had primary authors based in low-income countries.
• Common outcomes reported were mortality (85%), limb salvage (63%), and neurological impairment (48%).

Conclusions:

• Significant data gaps exist regarding prehospital tourniquet use in resource-limited settings.
• The lack of research originating from low-income countries highlights a critical disparity.
• Developing globally applicable, safe, and effective tourniquet guidelines requires addressing this research deficit.