Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

Abstract

Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings.

Deep vein thrombosis screening and risk factors in a high-risk trauma population

“…They concluded that this two-step screening strategy, as opposed to universal duplex for all patients, was effective in discovering DVTs that were carried over from acute care hospitals. The rationale against screening is not based on its inability to detect occult DVT; in fact, Jawa et al [14] pointed out that three investigations using the National Trauma Data Bank showed that higher rates of surveillance lead to a higher rate of DVT diagnosis. It is the uncertain clinical significance of finding an occult DVT that is the foundation of recommendations against screening practices.…”

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…In major trauma patients, screening for asymptomatic DVT has definitely been shown to detect more thrombi (Winemiller, 1999;Furlan, 2007;Pierce, 2008;Haut, 2009;Azarbal, 2011;Jawa, 2011;Dietch, 2015). Similarly, among acute SCI patients managed at the Mayo Clinic from 1976 to 1995, the use of DVT screening was the strongest predictor of a VTE diagnosis, with a risk ratio of 2.8-fold compared with patients not screened (Winemiller, 1999).…”

“…These studies demonstrate that routine screening will detect more asymptomatic DVTs but does not reduce symptomatic thromboembolic events. Implementation of a routine DVT surveillance program in the trauma service at the University of Nebraska Medical Center resulted in a fivefold increase in the number of DUS studies performed with no significant reduction in PE (Jawa, 2011). Three additional trauma studies reported that routine screening provided no incremental protection over early use of appropriate thromboprophylaxis (Schwarcz, 2001;Haut, 2007).…”

“…The costs of DVT screening are substantial, and routine screening of trauma patients has been shown to not be cost-effective (Borer, 2005;Jawa, 2011;Sud, 2011). Among high-risk trauma patients who were given thromboprophylaxis with LMWH, the addition of either serial DUS screening or insertion of an IVC filter was determined to cost more than USD $100,000 per nonfatal PE prevented (Brasel, 1997).…”

“…$180,000 more per year for additional DUS studies without any apparent clinical benefit (Jawa, 2011).…”