Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis

Malinoski, Darren; Ewing, Tyler; Patel, Madhukar S.; Jafari, Fariba; Sloane, Bryan; Nguyen, Brian L.; Barrios, Cristobal; Kong, Allen; Cinat, Marianne; Dolich, Matthew; Lekawa, Michael; Hoyt, David B.

doi:10.1016/j.injury.2011.10.006

Cited by 34 publications

(28 citation statements)

References 26 publications

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“…5 Other single-institution studies are plagued by similar limitations, and perhaps most importantly, an inability to demonstrate a reduction in PE as a result of screening. 8,11,4,12,3 …”

Section: Discussionmentioning

confidence: 99%

The “high-risk” deep venous thrombosis screening protocol for trauma patients

Dietch

Petroze

Thames

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Many centers advocate aggressive lower extremity deep venous thrombosis (DVT) screening using ultrasound (LUS) for patients meeting high-risk criteria. We hypothesized that a high-risk screening protocol is impractical and costly to implement. Methods The University of Virginia's trauma database was queried to identify 6,656 patients admitted between 2009 and 2013. Patient characteristics and outcomes were recorded. Multivariate analyses were performed on patients who underwent LUS to assess the association between patient characteristics and the development of DVT. A predictive model for DVT was applied to the entire population to determine performance and resources required for implementation. Results Overall, 2,350 (35.3%) of admitted patients underwent US. 146 patients (6.2%) developed DVT. Patients who underwent US were significantly older (54.5 vs. 50.4 years, p<0.0001), had higher injury severity scores (13.5 vs. 8.6, p<0.0001), and longer admissions to the intensive care unit (ICU) (5.6 vs. 0.9 days, p<0.0001). Backwards selection multivariable logistic regression identified ICU length of stay, transfusion of blood products, spinal cord injury, and pelvic fracture to be associated with DVT (c-statistic 0.76). The model was applied to the entire population to evaluate probability of DVT (c-statistic 0.87). Predictive performance and costs were determined using a cost per LUS of $228. The most sensitive threshold for screening would detect 53% of DVTs, require screening of 26% of all trauma patients, and cost nearly $600,000 to implement over the study period. Conclusions Although a predictive model identified high-risk criteria for the development of DVT at our institution, the model demonstrated poor sensitivity and positive predictive value. These results suggest that implementing a high-risk screening protocol in trauma patients would require a costly and burdensome commitment of resources and that high-risk DVT screening protocols may not be practical or cost-effective for trauma patients. Level of evidence Diagnostic tests or criteria, level III.

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“…5 Other single-institution studies are plagued by similar limitations, and perhaps most importantly, an inability to demonstrate a reduction in PE as a result of screening. 8,11,4,12,3 …”

Section: Discussionmentioning

confidence: 99%

The “high-risk” deep venous thrombosis screening protocol for trauma patients

Dietch

Petroze

Thames

et al. 2015

Journal of Trauma and Acute Care Surgery

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“…In these cases, debate about the role of prophylactic inferior vena cava (IVC) filters to prevent PE is ongoing. Some authors 7,8 suggest that using IVC filters among trauma patients at very high risk of PE may prevent the most dramatic and life-threatening cases. Other authors 9 suggest their use is not beneficial and should be curtailed.…”

mentioning

confidence: 99%

The Effectiveness of Prophylactic Inferior Vena Cava Filters in Trauma Patients

et al. 2014

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“…17 Four hundred and eleven multi-trauma patients were screened for DVT with lower limb Doppler ultrasound at 48 h and then weekly. 17 Four hundred and eleven multi-trauma patients were screened for DVT with lower limb Doppler ultrasound at 48 h and then weekly.…”

Section: Vte and Traumamentioning

confidence: 99%

“…All these factors are independently associated with VTE. 17 Soft tissue injuries and conservative management induce less thrombin production and less VTE than fractures and those who undergo surgical management. 14,15 The presence of an initial ATC is also associated with a higher risk of VTE.…”

Section: Vte and Traumamentioning

confidence: 99%

See 1 more Smart Citation

Review article: Do inferior vena cava filters prevent pulmonary embolism in critically ill trauma patients and does the benefit outweigh the risk of insertion? A narrative review article

Moynihan

Koelzow

2018

Emerg Medicine Australasia

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Venous thromboembolic disease (VTE) increases the risk of mortality in trauma patients. To decrease the occurrence of VTE, low dose anticoagulants are commonly prescribed. This may be unacceptable in trauma patients who have a high risk of bleeding. Inferior vena cava (IVC) filters can be employed as an alternative strategy to decrease the risk of pulmonary embolism (PE). Insertion of an IVC filter is an invasive procedure that has a range of complications. The benefits of IVC filter insertion must be compared to its risk of complications in each individual patient. A search of the literature since 2005 was conducted on MEDLINE, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials and Embase. The clinical question posed was does prophylactic IVC filter insertion decrease the risk of PE in trauma patients? The available evidence was low level and unable to definitively answer this question. The majority of articles infer that IVC filter insertion is safe and may decrease the risk of PE. However, there is a need for well-designed randomised controlled trials to be conducted in this area.

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Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis

Cited by 34 publications

References 26 publications

The “high-risk” deep venous thrombosis screening protocol for trauma patients

The “high-risk” deep venous thrombosis screening protocol for trauma patients

The Effectiveness of Prophylactic Inferior Vena Cava Filters in Trauma Patients

Review article: Do inferior vena cava filters prevent pulmonary embolism in critically ill trauma patients and does the benefit outweigh the risk of insertion? A narrative review article

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