B. M. Tracy1, C. O’Neal1, J. Dunne1 1Memorial University Medical Center,Surgery,Savannah, GA, USA
Introduction:
Trauma patients are at an increased risk of venous thromboembolism (VTE) for a multitude of reasons. The purpose of this study is to determine if delay in VTE prophylaxis initiation in neurosurgical trauma patients is associated with an increased incidence of VTE. Furthermore, we seek to identify the appropriate timing of initiation in various subgroups of VTEs as to prevent VTE development and not worsen the initial injury.
Methods:
With permission from our institutional review board, we performed a retrospective review of patients enrolled in Memorial’s TQIP database from 2010 to 2014. We included patients who sustained any traumatic brain or spinal cord injury (SCI), who were placed on chemical VTE prophylaxis. Our data points included date of arrival, date of initiation of chemical VTE prophylaxis, and presence or absence of VTE development. We stratified the patients into injury groups: subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), a combination of SAH/SDH together, any other brain hemorrhage (BH), concussions, and SCI. We compared all injury groups, then subdivided them into VTE and non-VTE development groups.
Results:
Of all the 2,062 neurosurgical trauma patients, 142 had SAH, 155 had SDH, 160 had SAH/SDH combinations, 91 had BHs, 1,497 had some form of isolated SCI, and 17 had only concussions. When all injuries were stratified, we found that the SAH/SDH group was started on prophylaxis significantly later at 8.3 days (±6.2) than SAH (p<0.01), SDH (p<0.01), BH (p<0.01), and SCI (p<0.01). Furthermore, isolated SCIs were all started on prophylaxis significantly earlier at 3.2 days (±4.3) compared to SAH (p<0.01), SDH (p<0.01) and BHs (p<0.01).
The overall time to initiation of chemical prophylaxis in the non-VTE group was 4.0 days (±4.8) compared to 6.2 days (±4.7) in the group that did develop VTEs (p<0.01). When further broken down by type of neurosurgical injury, there was also a significant delay in initiation of prophylaxis in the VTE subgroups SAH/SDH (p<0.01) and BHs (p<0.01) with and without SCI.
In the subgroups that developed VTEs, the SCI subgroup was started on chemical prophylaxis at 3.82 days (±2.74), which was significantly earlier than the SAH (p<0.01), SDH (p<0.01), SAH/SDH (p<0.01), and BH subgroups.
Conclusion: This study suggests that VTEs in patients with traumatic brain injuries correlate with an increase in time to initation of chemical prophylaxis. Specifically, SDH/SAH combinations are started significantly later than any other injury and carried the highest rate of VTE events. Future studies will investigate the relationship between the time to initation of chemical prophyalxis and worsening of the neurosurgical injury to devise a formalized protocol for management.