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Post-Mortem Evaluation of Potentially Survivable Hemorrhagic Death in a Civilian Population

journal contribution
posted on 2024-01-04, 03:58 authored by Craig Goolsby, Liz RouseLiz Rouse, Luis Rojas, Eric Goralnick, Matthew J Levy, Thomas Kirsch, Alexander L Eastman, Arthur Kellermann, Kandra Strauss-Riggs, Nicole Hurst
BACKGROUND: Although the survivability of military extremity hemorrhage is well documented, equivalent civilian data are limited. We analyzed statewide autopsy records in Maryland to determine the number of hemorrhagic deaths that might have been potentially survivable with prompt hemorrhage control. Similar analyses of battlefield deaths led to life-saving changes in military medical practice. STUDY DESIGN: This is a retrospective study of decedent records. The objective is to estimate the number of hemorrhagic deaths that might have been prevented by prompt placement of an extremity tourniquet. Maryland autopsy records from 2002 to 2016 were selected using the following search terms: amputation, arm/arms, avulsion, exsanguination, extremity/extremities, leg/legs. The records were analyzed by applying a checklist of previously developed military criteria to characterize deaths as potentially survivable or nonsurvivable with prompt use of a tourniquet. Suicides and decedents less than 18 years old were excluded. The study did not use information about living participants. Two expert reviewers independently evaluated and scored the death records. Deaths were classified as either potentially survivable or nonsurvivable. A third reviewer broke any ties. RESULTS: There were 288 full autopsy records included in the final analysis. Of the eligible decedents reviewed during the 14-year period, 124 of 288 had potentially survivable wounds; 164 had nonsurvivable wounds. CONCLUSIONS: Over the 14-year study interval, 124 Maryland decedents-an average of 9 per year-might have been saved with prompt placement of a tourniquet. If extrapolated, approximately 480 people in the US might be saved per year. These results provide evidence to support educating and equipping the public to provide bleeding control.

History

Journal

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS

Volume

227

Pagination

502-506

Location

United States

ISSN

1072-7515

eISSN

1879-1190

Language

English

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

5

Publisher

ELSEVIER SCIENCE INC