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

Christopher P. Michetti, Elizabeth Franco, Jonathan Coleman, Anna Bradford, Amber W. Trickey

Research output: Contribution to journalArticle

Abstract

RESULTS: Of 622 patients, 534 (86%) had screening duplex; 26 (4.8%) had an ARC DVT. A majority of 442 patients (71%) received enoxaparin prophylaxis in hospital, for a median 64% of hospital days. Of ARC DVT patients, 17 received full anticoagulation and 16 received vena cava filters. Thirty-seven patients had DVT diagnosed in the hospital (hospital DVT) before discharge to ARC. Hospital DVT and ARC DVT groups were comparable except shorter median hospital length of stay and lower head abbreviated injury scale in ARC DVT patients. On multivariate analysis, increased intensive care unit length of stay, age >65 y, a lower percentage of hospital days receiving chemoprophylaxis, and delayed initiation of chemoprophylaxis were significantly predictive of DVT after adjustment for sex, mechanism, injury severity score, and admission systolic blood pressure. Presence of pelvic fractures and ages 50-65 y also posed an increased risk.

CONCLUSIONS: The incidence of occult DVT on ARC admission is low in trauma patients. Several risk factors for DVT in the trauma ARC population were identified. Nonselective screening of all trauma patients on admission to ARC is not supported by this analysis.

BACKGROUND: Trauma patients requiring acute inpatient rehabilitation are significantly injured, with increased risk for deep vein thrombosis (DVT). We evaluated routine screening for occult DVT in such patients, and analyzed DVT risk factors.

MATERIALS AND METHODS: Data from level I trauma center patients discharged to a single acute rehabilitation center (ARC) from 2007-2011 were retrospectively reviewed. Routine lower extremity duplex was performed on ARC admission. Follow-up data were collected for patients with occult DVT (ARC DVT). DVT predictors were evaluated using logistic regression.

Original languageEnglish (US)
Pages (from-to)545-551
Number of pages7
JournalJournal of Surgical Research
Volume199
Issue number2
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Venous Thrombosis
Rehabilitation Centers
Wounds and Injuries
Population
Length of Stay
Chemoprevention
Abbreviated Injury Scale
Vena Cava Filters
Blood Pressure
Enoxaparin
Injury Severity Score
Trauma Centers
Patient Admission
Craniocerebral Trauma
Intensive Care Units
Inpatients
Lower Extremity
Rehabilitation
Multivariate Analysis

Keywords

  • Acute rehabilitation
  • DVT
  • Enoxaparin chemoprophylaxis
  • Risk factors
  • Screening
  • Trauma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Michetti, C. P., Franco, E., Coleman, J., Bradford, A., & Trickey, A. W. (2015). Deep vein thrombosis screening and risk factors in a high-risk trauma population. Journal of Surgical Research, 199(2), 545-551. https://doi.org/10.1016/j.jss.2015.04.069

Deep vein thrombosis screening and risk factors in a high-risk trauma population. / Michetti, Christopher P.; Franco, Elizabeth; Coleman, Jonathan; Bradford, Anna; Trickey, Amber W.

In: Journal of Surgical Research, Vol. 199, No. 2, 01.12.2015, p. 545-551.

Research output: Contribution to journalArticle

Michetti, CP, Franco, E, Coleman, J, Bradford, A & Trickey, AW 2015, 'Deep vein thrombosis screening and risk factors in a high-risk trauma population', Journal of Surgical Research, vol. 199, no. 2, pp. 545-551. https://doi.org/10.1016/j.jss.2015.04.069
Michetti, Christopher P. ; Franco, Elizabeth ; Coleman, Jonathan ; Bradford, Anna ; Trickey, Amber W. / Deep vein thrombosis screening and risk factors in a high-risk trauma population. In: Journal of Surgical Research. 2015 ; Vol. 199, No. 2. pp. 545-551.
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AB - RESULTS: Of 622 patients, 534 (86%) had screening duplex; 26 (4.8%) had an ARC DVT. A majority of 442 patients (71%) received enoxaparin prophylaxis in hospital, for a median 64% of hospital days. Of ARC DVT patients, 17 received full anticoagulation and 16 received vena cava filters. Thirty-seven patients had DVT diagnosed in the hospital (hospital DVT) before discharge to ARC. Hospital DVT and ARC DVT groups were comparable except shorter median hospital length of stay and lower head abbreviated injury scale in ARC DVT patients. On multivariate analysis, increased intensive care unit length of stay, age >65 y, a lower percentage of hospital days receiving chemoprophylaxis, and delayed initiation of chemoprophylaxis were significantly predictive of DVT after adjustment for sex, mechanism, injury severity score, and admission systolic blood pressure. Presence of pelvic fractures and ages 50-65 y also posed an increased risk.CONCLUSIONS: The incidence of occult DVT on ARC admission is low in trauma patients. Several risk factors for DVT in the trauma ARC population were identified. Nonselective screening of all trauma patients on admission to ARC is not supported by this analysis.BACKGROUND: Trauma patients requiring acute inpatient rehabilitation are significantly injured, with increased risk for deep vein thrombosis (DVT). We evaluated routine screening for occult DVT in such patients, and analyzed DVT risk factors.MATERIALS AND METHODS: Data from level I trauma center patients discharged to a single acute rehabilitation center (ARC) from 2007-2011 were retrospectively reviewed. Routine lower extremity duplex was performed on ARC admission. Follow-up data were collected for patients with occult DVT (ARC DVT). DVT predictors were evaluated using logistic regression.

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