CONVERT: Civilian outcomes of emergency department tourniquet conversion

Tourniquet conversion (TC) involves the removal of a tourniquet with the achievement of hemostasis using wound packing, hemostatic dressings, and/or pressure bandages as a less invasive method of hemorrhage control. TC is routinely performed in emergency departments to reduce ischemic complications associated with prolonged tourniquet use. Despite increasing civilian prehospital tourniquet application, empirical data guiding TC remain limited, and existing protocols rely largely on expert opinion.

We conducted a retrospective cohort study of trauma patients presenting with prehospital-applied extremity tourniquets to a Level I trauma center between March 2021 and December 2024. TC was defined as the removal of a tourniquet with replacement by wound packing, hemostatic dressings, and/or pressure bandages. Outcomes were categorized as successful conversion, procedural intervention, or operative intervention. Secondary outcomes included injury-related complications, attribution of complications to tourniquet use, and factors associated with delayed or failed conversion. Multivariable logistic regression was used to identify predictors of successful conversion.

Among 647 patients, 543 (83.9%) underwent successful TC in the emergency department without procedural or operative intervention. Median tourniquet duration was 40 minutes (interquartile range, 30-59). Sixty patients (9.3%) experienced injury-related complications, with none attributed to tourniquet use. Complications were more common in patients requiring operative intervention compared with those successfully converted (44.4% vs. 4.6%). Increasing tourniquet duration was independently associated with decreased odds of successful conversion per 30-minute interval [odds ratio (OR), 0.41; 95% CI, 0.32-0.53]. Upper extremity tourniquets were less likely to be successfully converted than lower extremity tourniquets (OR, 0.61; 95% CI, 0.38-0.97).

TC in the emergency department is successful for most patients with prehospital-applied tourniquets. Complications appear primarily related to the inciting injury rather than tourniquet use, particularly when the duration is under 2 hours. These findings support existing conversion protocols and highlight the importance of timely reassessment to minimize duration-associated complications. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Prognostic/Epidemiological; Level III.