Fasciotomy rates in operations enduring freedom and iraqi freedom: association with injury severity and tourniquet use.

OBJECTIVE To compare fasciotomy rates and Injury Severity Scores (ISSs) before and after tourniquets were fielded for combat casualties in March 2005. METHODS A military trauma registry was used to identify 4332 casualties with limb injury between 2003 and 2006. Descriptive statistics and regression analysis were used to compare changes in ISSs, limb Abbreviated Injury Scale (AIS) scores, and fasciotomy rates. An item of specific interest was whether changes in fasciotomy rates occurred before and after March 2005, when tourniquets were fielded. Therefore, this time point served as a specific comparator in the statistical analyses. RESULTS Among the 4332 limb casualties, 669 (15%) underwent fasciotomy. The ISS doubled (100% increase) during the study. Limb AIS increased 35%. The increase in limb AIS constituted most of the increase in ISS. Monthly fasciotomy rates increased 500% (5% to 30%) during the study. When controlling injury severity (both AIS and ISS), fasciotomy rates tripled (200% increase); but when comparing fasciotomy before and after tourniquet fielding by AIS and ISS, rates only doubled (100% increase). On logistic regression for predicting fasciotomy, the model was unable to determine a good fit for the data because the variables were not significant except weakly for injury severity. CONCLUSIONS During the period of the study, fasciotomy rates increased as a result of a combination of factors: increasing injury severity, increasing use of tourniquets, and increased awareness of the need to perform prophylactic fasciotomy. Further research should be aimed at determining what the optimum rate of fasciotomy is in such an environment.