In-hospital DVT detection, thromboprophylaxis practice, and guideline adherence in patients with traumatic fractures:...

Deep vein thrombosis (DVT) is a major complication in patients with traumatic fractures. Although clinical guidelines recommend risk stratification and appropriate thromboprophylaxis, the burden of in-hospital detected DVT remains high.

To evaluate in-hospital DVT detection, the discriminative ability of the modified Caprini score, and thromboprophylaxis guideline adherence in hospitalized patients with traumatic fractures.

This retrospective real-world study included 13,990 patients with traumatic fractures admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2019 to October 2024. Demographic characteristics, comorbidities, fracture characteristics, and clinical data were extracted from electronic medical records. Patients were stratified into very-low-risk, low-risk, moderate-risk, and high-risk groups according to the modified, retrospectively reconstructed Caprini Risk Assessment Model, and thromboprophylaxis practice across risk categories was analyzed.

Among 13,990 hospitalized patients with traumatic fractures, DVT was detected during hospitalization in 1765 patients (12.62%). In the operational guideline-adherence analysis, restricted to patients for whom routine thromboprophylaxis was recommended and excluding patients whose prophylaxis was initiated only after DVT detection, 13,156 patients were included; 8121 (61.73%) received recorded pharmacological or mechanical thromboprophylaxis, and 6065 (46.10%) received guideline-concordant prophylaxis. Thromboprophylaxis use increased with higher risk categories, whereas overall guideline adherence remained suboptimal. The modified Caprini score showed moderate discrimination for in-hospital detected DVT.

Approximately one in 8 hospitalized patients with traumatic fractures had DVT detected during hospitalization. Significant gaps in thromboprophylaxis practice and guideline adherence persist in real-world clinical settings. Improved risk assessment and optimized implementation of guideline-based thromboprophylaxis may help improve real-world VTE prevention practice in patients with traumatic fractures.