Compliance with Sequential Compression Device Prophylaxis in At-Risk Trauma Patients: A Prospective Analysis

Abstract

The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). “Full compliance” was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT risk factors were common (83%) and adjunctive heparin prophylaxis was infrequent (27%). The most common times for “noncompliant” observations were early afternoon and midmorning. On multivariate analysis only spinal column injury correlated with increased compliance. In nearly half of the observations trauma patients at risk for DVT were not receiving their SCD prophylaxis as per physician orders. Fewer than 20 per cent of patients had the devices on and functioning during each of the six observations during a 24-hour period. These data point to the need for education of hospital staff and for additional prophylactic measures in at-risk patients.

Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta‐Analysis

“…This finding was marginally significant after taking the effect of heparin type into account and also requires confirmation in further studies. Another compression-associated factor that must be considered is the potential for noncompliance, which may often occur, particularly in trauma patients [34]; outside of the rigor of RCTs, compliance may be decreased. Blinded studies appeared to be more likely to report higher risk of DVT with compression, compared with heparin, than unblinded studies.…”

Intermittent Pneumatic Compression in Addition to Standard Prophylaxis of Postoperative Venous Thromboembolism in Extremely High-risk Patients (IPC SUPER): A Randomized Controlled Trial

“…Compliance with IPC is another crucial issue. By providing 6-hour night intervals without compression and removing sleeves before any attempt to get out of the bed while maintaining 18 hours of compression daily except the period of ambulation, we achieved very high compliance with IPC that exceeds previously published thresholds of 40%–50% 23–26 . It is important that we recorded not the only application of sleeves but confirmed operation of the pump, which is not always the same 25 .…”

“…except the period of ambulation, we achieved very high compliance with IPC that exceeds previously published thresholds of 40%-50%. [23][24][25][26] It is important that we recorded not the only application of sleeves but confirmed operation of the pump, which is not always the same. 25 All of these factors accompanied by the use of a single consistent, well-established IPC device formed the basis for the favorable trial results.…”

Posttraumatic Thromboprophylaxis Revisited: An Argument Against the Current Methods of DVT and PE Prophylaxis after Injury

“…The purpose of this report is not to claim that there is proof of absence of efficacy but rather that there is absence of proof of efficacy. For reasons relating to the physiologic response to injury34 or to logistics and compliance,23 the current methods of thromboprophylaxis may not do what we believe they do. Only if we visit this issue with wide‐open eyes and renewed interest will we be able to uncover the truth.…”

“…In a prospective randomized trial of patients with pelvic fractures, no significant difference in VT rates was found between those with SCD and those with no prophylaxis 22. A possible explanation for the failure of SCD to prevent VT was offered by the bicenter study reporting on trauma patient compliance with SCD 23. In this prospective study, 1,343 observations were made on 227 patients who had physician orders for SCD prophylaxis.…”