B. K. Yorkgitis1, O. Olufajo1, G. Reznor1, J. M. Havens1, D. Metcalfe1, Z. Cooper1, A. Salim1 1Brigham And Women’s Hospital,Trauma, Burns And Surgical Critical Care,Boston, MA, USA
Introduction: It is well known that trauma patients are at increased risk for venous thromboembolism (VTE). Because many patients require initial stabilization followed by transfer to a higher level of care, administration of VTE prophylaxis may often be delayed. It is unclear if these patients are actually at increased risk for VTE. As VTE has become a quality metric for trauma centers, it is important to know if there is an actual increased risk for patients transferred.
Methods: The National Trauma Database (NTDB) v6.2 (2007-2012) was used to identify patients admitted to Level I and II trauma centers. Patients receiving anticoagulants, <18 years, or pregnant were excluded. Patients transferred <24 hours were compared to non-transferred patients with respect to age, sex, race, patient-level risk factors for VTE, and VTE rates. Multivariable logistic regression models were used to identify risk factors for deep venous thrombosis (DVT), pulmonary embolism (PE), and VTE. All calculations were done with SAS 9.3 SURVEYLOGISTIC and SURVEYFREQ procedures to include NTDB weights, strata and clustering to create nationally representative estimates. Alpha was set on P= 0.05.
Results:There were 736,374 trauma patients identified for analysis during with 189,166 (25.7%) patients transferred to a level I or II trauma center within 24 hours of injury. A total of 11,619 (1.5%) developed VTE including 9,149 (78.8%) with DVT and 3,167 (21.2%) with PE. The VTE rate was significantly higher in the transferred group compared to the non-transferred group (1.73% vs. 1.42%, p=0.002). Significant differences exist with respect to DVT (1.39% vs. 1.14%, p=0.004) and PE (0.45% vs. 0.37%, p=0.003) between transferred and non-transferred patients respectively. Multivariable analyses adjusting for patient-level risk factors demonstrated that transferred patients were independently associated with a higher likelihood of VTE (OR 1.15; 95% CI: 1.06 – 1.25, P=0.001 ), PE (OR 1.18; 95% CI: 1.08 – 1.30, p<0.001), and DVT (OR 1.13; 95% CI: 1.04 – 1.25, p=0.007).
Conclusion: Adult trauma patients transferred to a level I or II center that initially presented to another facility are at increased risk for VTE. Further studies are necessary to determine the causes for this increased risk. Accepting a transferred trauma patient results in an increased VTE risk and may not be reflective of the quality of trauma care at the receiving facility.