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- Categorized in: Battlefield Medicine, Department of Defense (DoD), Department of Veterans Affairs (VA), October 2011
Longer Term Study: Tourniquets Saves Lives on Battlefield
Morbidity is minor in light of the major survival benefits associated with emergency tourniquet use on the battlefield, a recent study concluded.
In a study published in Military Medicine, researchers evaluated tourniquet use at a U.S. combat support hospital in Baghdad, Iraq. In prior reports, they said they demonstrated that early use of emergency tourniquets is associated with improved survival and only minor morbidity.
In order to see if their research results were consistent over time, the researchers continued evaluation of tourniquet use for an additional six months at a combat-support hospital in Baghdad.
“Our objective was to analyze emergency tourniquet use to assess consistency in results,” the authors wrote.
The study group included 232 casualties from the first time period and 267 casualties from the second time period.
“The patients were severely injured, with high risk of shock, coagulopathy and death,” they explained in the study.
The study results were consistent for both groups, the authors found.
“The first and current study were similar for the number of patients (232 vs. 267), deaths (31 vs 34), palsies at the level of the tourniquet (5 vs. 4), and limbs with major shortening (1 vs. 1). These data were similar, so the results were consistent,” they wrote.
The authors wrote that, given “minor morbidity risk in light of major live-saving benefit,” the policy of “encouraging emergency tourniquet use” was warranted.
Col. John F Kragh Jr., MC USA; Capt Michelle L O’Neill, AN, USA; Thomas J Walters, PhD’ John A Jones, BS; David G baer, PhD; Leigh K Gershman, BS; Charles Wade, PhD, John B Holcomb, MD. Minor “Morbidity With Emergency Tourniquet Use to Stop Bleeding in Severe Limb Trauma: Research, History, and Reconciling Advocates and Abolitionists.” Military Medicine, 176, 7:817, 2011.
Study Assesses Relationship of Anticoagulation Knowledge and Control
A recent study sought to assess the knowledge level of patients receiving warfarin therapy in an anticoagulation clinic using the validated Anticoagulation Knowledge Assessment (AKA) questionnaire. In addition, the study examined the relationship between patient anticoagulation knowledge and anticoagulation control as measured by the international normalized ratio (INR).
For the study, all patients seen during their routine visit at the Alvin C. York Veterans Affairs anticoagulation clinic within an eight-week recruitment period from February 2010 to April 2010 were asked to complete the AKA questionnaire. Upon voluntary consent the patients completed the questionnaire either during the clinic visit or returned it later by mail. Demographic and clinical data were taken from the computerized patient record system.
The researchers defined a passing score as at least 21 correct responses on the 29-item AKA questionnaire (72.4% correct).
“INR control was defined by three outcome measures: number of INRs within therapeutic range, time in therapeutic range (TTR) calculated using the Rosendaal method and standard deviation (SD) of INR values. Anticoagulation knowledge was assessed with two measures: total AKA score and count of correct answers to a subset of 15 AKA items deemed by the investigators to be relevant to INR control,” the study abstract stated.
Of the 447 patients enrolled in the anticoagulation clinic, 260 consented to participate in the survey, of whom 185 patients completed the AKA instrument and were matched to patient record system data.
The majority of patients had been treated with warfarin for at least one year (n=162, 87.6%). Most patients had goal INR ranges of 2.0 to 3.0 (n=166, 89.7%). Of the 185 patients who completed the questionnaire, 74.1% achieved a passing score. The mean (SD) AKA questionnaire score was 78.1%. For the 167 patients who had been on warfarin therapy for at least six months and had 10 previous INR values, there was no significant Spearman's rho correlation between total number of correct questionnaire responses and INR control.
“Although 74.1% of patients on long-term warfarin therapy achieved a passing score of at least 21 correct answers on the 29-question AKA instrument, there was no significant relationship between patient warfarin knowledge and INR control. Areas for improvement in patient education have been identified and procedures for educational modification are currently in development,” the study authors concluded.
INR goal attainment and oral anticoagulation knowledge of patients enrolled in an anticoagulation clinic in a Veterans Affairs medical center. Baker JW, Pierce KL, Ryals CA. J Manag Care Pharm. 2011 Mar;17(2):133-42.
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