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Updated: Jun 19, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Does preperitoneal packing increase venous thromboembolim risk among trauma patients? A prospective multicenter
Lisa Marie Knowlton1, Angela Sauaia, Ernest E Moore
1From the Section of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (L.M.K.), Stanford University School of Medicine; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE) (L.M.K.), Stanford, California; Department of Surgery (A.S., E.E.M.), University of Colorado Denver, Aurora; Ernest E Moore Shock Trauma Center (A.S., E.E.M.), Denver Health, Denver, Colorado; and Department of Surgery (M.M.K.), University of California San Francisco, San Francisco, California.
Introduction:
Pelvic fractures are associated with a high risk of venous thromboembolism (VTE). Among treatment options, including pelvic angioembolization (PA), preperitoneal pelvic packing (PPP), and pelvic open reduction internal fixation (ORIF), PPP has been postulated as a VTE risk factor. We aimed to characterize the risk of VTE among pelvic fracture patients receiving PPP, PA or ORIF.
Methods:
We used observational data from a 17-site Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group, a US level I trauma center collaborative working to identify factors associated with posttraumatic VTE, deep venous thrombosis, pulmonary embolism, or pulmonary thrombosis. The CLOTT criteria included age 18 to 40 years with at least one independent VTE risk factor. We compared outcomes of PPP, PA, and pelvic ORIF to reference of no pelvic intervention. Our primary outcome was VTE. A competing risk analysis was performed.
Results:
Among 1,387 pelvic fracture patients, VTE incidence was 5.6%. The ORIF patients were most likely to develop VTE (24.7%), while VTE incidence for PPP was 9.0% and 2.6% for PA. After multivariate, risk-competing analysis, none of the three treatment interventions for pelvic fractures were significantly associated with VTE. Initiation of VTE prophylaxis in the first 24 hours of admission independently halved VTE incidence (hazard ratio, 0.55; confidence interval, 0.33-0.91).
Conclusion:
Pelvic fracture interventions do not appear to be independent risk factors for VTE in our study. Initiation of VTE pharmacoprophylaxis within the first 24 hours of admission remains critical to significantly decreasing VTE formation in this high-risk population.
Level Of Evidence:
Therapeutic Study; Level III.
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