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Practice Variation in Vena Cava Filter Use Among Trauma Centers in the National Trauma Database
Timothy C Gilligan1, Alan D Cook2, David W Hosmer3
1William Beaumont Army Medical Center, El Paso, Texas.
The Journal of Surgical Research
|October 4, 2019
Summary
Practice patterns for vena cava filters (VCFs) in trauma patients vary significantly across trauma centers. This variation is not solely due to patient factors, suggesting other influences on VCF use.
Area of Science:
- Medical research
- Trauma surgery
- Vascular intervention
Background:
- Indications for vena cava filter (VCF) use in trauma patients have evolved.
- VCF technology and practice guidelines have changed over time.
- This study investigates variations in VCF placement among trauma centers.
Purpose of the Study:
- To examine the variation in vena cava filter (VCF) placement among trauma centers.
- To compare interfacility practice variation in VCF utilization.
- To identify predictors of VCF placement in trauma patients.
Main Methods:
- Retrospective analysis of the National Trauma Data Bank (2005-2014).
- Grouping trauma centers based on VCF placement (VCF+/VCF-).
- Multivariable probit regression to predict expected VCF use and calculate observed-to-expected ratios (O:E).
Main Results:
- 65,482 VCFs were placed by 448 centers; 4.3% of centers placed no VCFs.
- Deep vein thrombosis, spinal cord paralysis, and major procedures predicted VCF placement.
- Observed-to-expected (O:E) ratios varied by nearly 500% among centers that placed VCFs.
Conclusions:
- Significant practice variation exists in VCF placement for trauma patients.
- Patient characteristics alone do not explain this variation.
- Conflicting guidelines, evolving evidence, reimbursement, and center culture may influence VCF utilization.
