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Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results
F B Rogers1, S R Shackford, J Wilson
1Department of Surgery, University of Vermont College of Medicine, Burlington 05405.
Insights
Pulmonary embolism (PE) is a risk for trauma patients. Vena cava filters (VCFs) effectively reduced PE incidence in high-risk trauma patients, proving safe and beneficial.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality in trauma patients.
- A 5-year review identified a 1% incidence of PE in 2525 trauma admissions.
- High-risk groups included severe head injury, spinal cord injury with deficit, and pelvic/long bone fractures.
Purpose of the Study:
- To evaluate the efficacy and safety of vena cava filters (VCFs) for PE prophylaxis in high-risk trauma patients.
- To assess the impact of VCFs on the overall incidence of PE in the trauma population.
Main Methods:
- A retrospective review identified high-risk trauma patients.
- Vena cava filters (VCFs) were percutaneously inserted in 34 high-risk patients starting July 1991.
- Patients were monitored for complications and PE development.
Main Results:
- VCF insertion was performed without complications.
- 17.6% of patients with VCFs developed deep vein thrombosis (DVT).
- No pulmonary embolism (PE) events occurred in the VCF group, and overall PE incidence decreased from 1% to 0.25% (p < 0.05).
Conclusions:
- Vena cava filters (VCFs) are safe and effective in preventing pulmonary embolism (PE) in high-risk trauma patients.
- Prophylactic VCF insertion significantly reduces PE incidence in the general trauma population.
- This intervention improves outcomes for trauma patients at high risk for PE.
Abstract:
Pulmonary embolism (PE) remains a significant problem in trauma patients. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma patients (1% incidence). Three groups of high-risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of PE in these high-risk patients was 21 to 54 times that of the general trauma population. Beginning in July 1991, as prophylaxis against PE, vena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted percutaneously in the radiology suite without complications. On follow-up examination, 17.6% developed documented lower extremity deep vein thrombosis. There were no PEs. Overall, the incidence of PE in the general trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi 2). We conclude that insertion of VCFs in high-risk trauma patients is safe and efficacious in decreasing the incidence of PE.