D. Koganti1, A. Johnson1, S. Stake1, A. Wallace1, S. Cowan1, J. Marks1, M. Cohen1 1Thomas Jefferson University,Surgery,Philadelphia, PA, USA
Introduction:
Now that deep vein thrombosis (DVT) is linked to reimbursement and publicly reported metrics, hospitals are pressuring trauma programs to discourage lower extremity (LE) venous duplex ultrasounds (VDUS) in asymptomatic patients. Current evidence is ambiguous and controversial. We aimed to evaluate LE VDUS screening practices at our institution for risk reduction for pulmonary embolism (PE).
Methods:
Patients admitted to an urban level-1 trauma center between 2005 and 2015 were retrospectively reviewed, excluding patients with a length of stay (LOS) <4 days. We performed propensity-matching of screened to unscreened patients based on gender, transfer, spinal procedure, spinal cord injury, or spinous, femur, pelvis, tibia and upper extremity fracture. In our matched samples, we performed a chi-squared analysis to determine association of screening with PE, absolute risk reduction and number needed to treat.
Results:
Of the 11,280 trauma patients admitted, 5,611 met LOS criteria. Of these patients, 2,687 (48%) underwent asymptomatic LE VDUS screening. Propensity matching identified 1,915 unscreened patients with a similar risk profile. The rate of PE was significantly higher in our matched unscreened sample [1.72% (n=33) vs 0.45% (n=12), p<0.001, Figure]. The absolute risk reduction was 1.28%, suggesting that the number needed to screen to prevent one PE is 78 high-risk patients.
Conclusion:
The data demonstrate significant risk reduction for pulmonary embolism in propensity-matched patients at our institution over a 10-year period. The screened patients still have a higher risk factor profile than the matched cohort suggesting that the actual risk reduction might even be greater than 1.28%. This data can help define the best population for routine screening and determine the cost-effectiveness of screening programs.
