Trauma Patients Who Exsanguinated Due to Peripheral Injury Potentially Salvageable by Stop the Bleed Techniques

Trauma patients may die of external bleeding from junctional or peripheral injuries. Most peripheral injuries are compressible allowing for temporary bleeding control in the field. Despite the availability of simple techniques to control external hemorrhage, patients still die of extremity and junctional bleeding. The American College of Surgeons stop the bleed (STB) program was designed to help members of the public control bleeding at the scene of trauma. Our study seeks to quantify trauma mortality that could have been prevented by STB techniques.

This is a retrospective case series of patients from a level one trauma center and the National Trauma Data Bank (NTDB). We selected overall deaths and patients who died within 2 days of injury and reviewed every injury that these patients suffered. We classified injuries into noncompressible, possibly compressible, and definitely compressible. We analyzed the patterns of injuries and identified a group of patients that we believe could have been saved with STB techniques. To assess possible benefit of STB, we analyzed the changes in the incidence of exsanguinating distal extremity injuries and the mortality rate of patients who suffered these injuries over the years 2017 through 2022.

For the local data, total early deaths were 577 (3.9% of total trauma). Ten (1.73%) of these patients died of an injury judged compressible by the reviewing trauma surgeon. For the NTDB data, total trauma patients were 6,715,967. Total deaths were 244,295 (3.6%). Total early deaths were 129,723 (1.9%). The proportion of total deaths due to isolated compressible injuries was 1079/244,295 (0.4%). This last group includes the patients that we believe could have been saved by STB. Over the 6-year period examined, there was a slight but significant rise in the mortality rate of isolated distal extremity injuries, but the incidence did not change significantly.

The problem of exsanguination from external bleeding still exists at a busy urban level one trauma center and at other trauma centers nationwide. Ongoing fatality reveals a continuing unmet need for public education that could potentially save lives.