Optimizing Lower Extremity Duplex Ultrasound Screening After Traumatic Injury

Area of Science:

• Trauma surgery
• Vascular imaging
• Patient risk stratification

Background:

• The Risk Assessment Profile (RAP) score guides lower extremity duplex ultrasound screening (LEDUS) for trauma patients.
• Current protocols may lead to overutilization of LEDUS.
• A need exists to optimize LEDUS protocols to reduce resource use without compromising patient outcomes.

Purpose of the Study:

• To evaluate the impact of a revised LEDUS protocol on the number of screenings performed and patient outcomes.
• To test the hypothesis that increasing the RAP score threshold and shortening the time to initial screening would reduce LEDUS utilization.

Main Methods:

• Retrospective review of trauma patients from two periods: 2014-2015 (RAP ≥5, screening day 4) and 2016-2017 (RAP ≥8, screening day 2).
• Data collected included demographics, injury characteristics, LEDUS findings, chemoprophylaxis, and venous thromboembolism (VTE) incidence.
• Both protocols involved weekly ultrasounds post-initial examination.

Main Results:

• LEDUS examinations decreased from 602 (2014-2015) to 412 (2016-2017).
• No significant difference in deep vein thrombosis (DVT) or pulmonary embolism (PE) incidence was observed between cohorts.
• Patients diagnosed with DVT in the revised protocol cohort had higher RAP scores and earlier diagnosis.

Conclusions:

• Refining LEDUS protocols by adjusting the RAP score threshold and timing of initial screening can decrease overutilization of hospital resources.
• Optimized LEDUS protocols maintain the quality of care and do not compromise outcomes for trauma patients regarding VTE detection.