J. E. Baker1, G. E. Niziolek1, N. Elson1, A. Pugh1, V. Nomellini1, A. T. Makley1, T. A. Pritts1, M. D. Goodman1 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA
Introduction:
Venus thromboembolism (VTE) remains a significant cause of morbidity and mortality after traumatic injury. Multiple assessment strategies have been developed to determine which patients may benefit from lower extremity duplex ultrasound (LEDUS) screening for deep vein thrombosis (DVT). We hypothesized that screening within 48 hours of admission and in patients with a Risk Assessment Profile (RAP) ≥ 8 would result in fewer LEDUS screening exams performed and a shorter time to VTE diagnosis without increasing the rate of VTE-related complications.
Methods:
A retrospective review was conducted on trauma patients admitted from 7/1/2014-6/30/2015 and 7/1/2016-6/30/2017. In 2014-2015, patients with a RAP score ≥ 5 underwent weekly screening LEDUS exams starting on hospital day 4. By 2016-2017, the protocol was changed to start screening patients with a RAP score ≥ 8 by hospital day 2. Patients were identified based on the aforementioned criteria and demographic data, injury characteristics, LEDUS exam findings, chemoprophylaxis type, and time of initial administration were collected.
Results:
In 2014-2015 a total of 3920 patients underwent evaluation by the trauma team, while in 2016-2017 a total of 4213 patients underwent trauma evaluation (Table). Fewer LEDUS exams were performed in 2016-2017. Of those patients who underwent screening LEDUS exams, a significantly higher RAP score and ISS score were demonstrated in 2016-2017. No significant difference was seen in the number of patients presenting with DVT or pulmonary embolism (PE) between the two cohorts. DVTs were most often identified on the first LEDUS exam in both cohorts. Of patients in whom a DVT was diagnosed on screening LEDUS exam, a significantly higher RAP score (12 vs. 10), a shorter time to first duplex (1 vs. 3 days), and a shorter time to DVT diagnosis (2 vs. 4 days) were observed in the 2016-2017 cohort. There was no significant difference in the time to initiate VTE prophylaxis, the number of DVTs found, the type of DVTs found, or the treatment of the DVTs. In patients who were found to have PE, no significant differences were demonstrated between RAP score, time to VTE prophylaxis, time to PE, percentage of patients with a DVT as well as PE, or reasons for duplex performed in all cohorts.
Conclusion:
By changing LEDUS screening to a RAP ≥ 8 and within 48 hours of admission, fewer duplexes were performed and the majority of DVTs were found earlier without a difference in DVT location or PE incidence. Refinement of lower extremity Doppler ultrasound screening protocols decreases over-utilization of hospital resources without compromising patient outcomes.
