Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism

Abstract

IntroductionClinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.MethodsA retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.ResultsThe incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4–9), and the median TESS for those with VTE was 10 (IQR 9–11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).ConclusionsWhen used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.Level of evidenceLevel III.

Tranexamic acid administration and pulmonary embolism in combat casualties with orthopaedic injuries

“…Factors identified by our clinical and injury models are similar to those seen in separate studies of risk factors for VTE after severe military and civilian trauma. [ 10 , 23 , 26 , 40 , 41 ] Similar predictive models have also implicated several risk factors we identified including injury severity, spinal injury, and other orthopaedic injuries, with a similar predictive power, although these did not evaluate TXA use and none exclusively considered patients with orthopaedic injuries. [ 42 – 44 ]…”

Trauma-induced pulmonary thromboembolism: What's update?

“…Studies suggest that an optimal high-risk cut-off value of TESS ≥7 demonstrates a high sensitivity in predicting VTE. 53 , 54 …”

“…Patients with a TESS ≥7 is at a high risk of VTE and should receive prophylaxis earlier. 53 , 54 Studies have shown that an ISS ≥10 suggests that pharmacologic prophylaxis should be initiated as soon as possible, whereas patients with an ISS<10 are at a lower VTE risk and may not require pharmacologic prophylaxis. 46 , 53 Patients with minor trauma may not require pharmacologic prophylaxis.…”

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

“…The retrospective MATTERs (military application of tranexamic acid in trauma emergency resuscitation) study demonstrated that the rate of all-cause mortality among patients who underwent emergency resuscitation in military combat was significantly lower among those who received TXA than those who did not (17.4% vs. 23.9%), but VTE incidence in the TXA group was about 10 times that in the untreated group [ 65 ]. A retrospective cohort study of 549 combat casualties admitted to US military hospitals from October 2010 to November 2012 also indicated that TXA was an independent risk factor for the development of VTE [ 66 ]. According to a retrospective analysis of 3773 military casualties, the use of TXA was not associated with mortality but did increase the risk of VTE [ 67 ].…”