D. Freitas1, E. Warnack1, M. Kim1, C. DiMaggio1, S. Frangos1, M. Klein1, C. Berry1, M. Bukur1 1New York University School Of Medicine,New York, NY, USA
Introduction:
The mangled lower extremity (MLE) is a limb sustaining complex structural injuries (i.e. soft tissue, bone, nerves, and vessels) resulting from a high- energy mechanism. We hypothesized that trauma patients who present with MLE experience a higher rate of deep venous thrombosis (DVT) and pulmonary embolism (PE) when matched with trauma patients of similar injury burden without MLE.
Methods:
Data were abstracted from the Trauma Quality Improvement Program (TQIP) database from 2013- 2016. Characteristics of blunt trauma patients who presented with MLE versus all other patients were compared using Chi-squared, Student’s t-test, or Mann-U Whitney test where appropriate. Propensity score matching, using a 2:1 match of controls versus patients with MLE, was used to compare the occurrence of DVT and PE.
Results:
A total of 1,060 patients presented with MLE from 2013 through 2016. Patients with MLE were younger (median age 42 IQR [28,54] vs. 54 [32,72], p < .001) and were more likely to need immediate operative intervention when compared to other trauma patients (60.5% vs. 11%, p < .001). In controlled models, while patients with MLE had a higher odds of receiving VTE prophylaxis (86% vs. 58.8%, AOR = 3.23, p < .001) and filter placement (6% vs. 1.5%, AOR = 2.81; p < .001), they were over two times more likely to experience DVT (5.4% vs. 1.4%, AOR 2.5, p < .001) or PE (2.3% vs. 0.6%, AOR 2.07, p = .155), although the latter was not statistically significant. In a propensity score model, MLE conferred a significant absolute risk increase of 3.6% for DVT or PE with an odds ratio of 2.43 (7% MLE vs. 3.3% no MLE). Mortality was not significantly lower in MLE patients versus other trauma patients (4.5% vs. 5.5%, p = .157).
Conclusion:
Trauma patients with MLE have a 2.4 times higher odds of having a DVT or PE with an absolute risk increase of 3.6%. Early aggressive prophylactic measures are warranted in this high-risk population.
