BACKGROUND: A pulseless limb is considered a hard sign of an @entity1317 after penetrating @entity130 in the civilian population. However, the reliability of this finding has never been examined in combat @entity130 . The purpose of this study was to examine the reliability of the pulseless limb in the combat @entity130 population. Reasons for false positive physical examination findings were also identified. METHODS: The Joint Theater @entity130 Registry identified all @entity1 who presented to a military treatment facility (MTF) in Kandahar, Afghanistan, with a penetrating @entity130 over a 2-year period. @entity1 found to have a pulse deficit on initial physical examination were followed, and the results of the subsequent computed tomographic angiogram or arteriogram recorded. @entity1 demographics, injury patterns, and physiological data were examined. Standard statistical analysis was performed. RESULTS: From 2011 to 2012, 644 @entity1 were treated at a single MTF for lower extremity penetrating @entity130 . The most common mechanisms of injury were explosions (62%) and gunshot wounds (20%). Of the 577 @entity1 with complete medical records, 448 @entity1 (78%) presented with palpable pulses, 115 @entity1 (20%) presented with a pulseless limb, and 14 (2%) presented with hard signs of @entity1317 . Of those with a pulseless limb and abnormal ankle-brachial index (ABI) or no ABI obtained who underwent further radiologic imaging, 38 @entity1 (77%) had no @entity1317 identified. Compared with those with a palpable pulse, @entity1 with a pulseless limb without an @entity1317 were more likely to have a higher Injury Severity Score (ISS), lower hematocrit, lower pH, greater base deficit, higher heart rate, more frequent use of tranexamic acid, and received greater volumes of packed red blood cells, plasma, and crystalloids. CONCLUSIONS: Our results demonstrate that a pulseless limb is a poor predictor of @entity1317 and should not be considered a hard sign of @entity1317 in the combat population. Variables including a high ISS, @entity417 , @entity520 , and need for resuscitation products, each a surrogate for injury severity, may contribute to the decreased accuracy of the physical examination in our troops. This may translate into unnecessary immediate exploration or other interventions in @entity1 who present with more significant @entity130 from the battlefield. Future studies must continue to focus on improved algorithms for diagnostic accuracy of @entity1317 in this population.

A pulseless limb poorly predicts an XXXX in combat @entity130 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'Patient'] @entity417 :: ('MESH:D000740', 'Disease') :: ['anemia'] @entity520 :: ('MESH:D000138', 'Disease') :: ['acidosis'] @entity1317 :: ('MESH:D057772', 'Disease') :: ['arterial injury', 'vascular injury', 'extremity vascular injuries'] @entity130 :: ('MESH:D014947', 'Disease') :: ['injuries', 'Trauma', 'extremity injury', 'trauma']
@entity1317 :: (MESH:D057772,Disease) :: ['arterial injury']
