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Venous thromboembolism after trauma: a never event?*
Chad M Thorson1, Mark L Ryan, Robert M Van Haren
1Division of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Critical Care Medicine
|August 15, 2012
Summary
A risk assessment profile can identify high-risk trauma patients for venous thromboembolism (VTE) screening. This approach helps in early detection of asymptomatic deep vein thrombosis, guiding potential interventions in trauma care.
Area of Science:
- Trauma care and critical illness management.
- Vascular surgery and interventional radiology.
- Health economics and policy in healthcare.
Background:
- Venous thromboembolism (VTE) rates after trauma are high, yet no standard screening protocol exists.
- Potential Medicare policy changes classifying VTE as a "preventable complication" could impact urban trauma centers.
- Current thromboprophylaxis strategies show no significant difference in VTE rates.
Purpose of the Study:
- To evaluate a prescreening risk assessment profile followed by routine venous duplex ultrasound for identifying asymptomatic VTE in trauma patients.
- To determine independent predictors for VTE development in trauma patients.
- To inform policy decisions regarding VTE management in trauma care.
Main Methods:
- Prospective, observational trial at a Level I trauma center ICU.
- 534 patients underwent prescreening with a risk assessment profile upon admission.
- 106 high-risk patients (score >10) received routine venous duplex ultrasound screening.
Main Results:
- Venous duplex ultrasound detected asymptomatic deep vein thrombosis in 19% of high-risk patients.
- Overall VTE rate was 28%, including symptomatic deep vein thrombosis and pulmonary emboli.
- Independent predictors for VTE included high-risk assessment score and pelvic fracture with prolonged operative intervention.
Conclusions:
- Medicare's "never event" classification for post-trauma VTE warrants reevaluation.
- Risk assessment profiles identify trauma patients at high risk for VTE, suggesting a need for targeted screening or aggressive prophylaxis.
- Routine venous duplex ultrasound may not be universally cost-effective, but prescreening identifies candidates who could benefit.
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