D. Harris1, D. Corbin1, J. Gibson1, C. Hardman2, A. P. Ekeh1,2 1Wright State University,Boonshoft School Of Medicine, Department Of Surgery,Dayton, OH, USA 2Wright State Physicians,Surgery,Dayton, OHIO, USA
Introduction: Injured patients are known to have a high incidence of Deep Venous Thrombosis (DVT) despite prophylactic measures. Increased rates of DVT is correlated with high rates of pulmonary embolism (PE) which is recognized to be a leading cause of death in trauma patients who survive beyond 24 hours. Routine screening for DVT in asymptomatic trauma patients is practice aimed at identifying thromboembolic events and initiating early treatment. We evaluated our trauma DVT screening protocol involving routine Duplex ultrasound at one week for patients still hospitalized at post trauma day 7 and weekly thereafter.
Methods: All adult patients admitted to a Level I trauma center who had a least one positive Duplex Ultrasound DVT screen over a 70-month period (Jan 2013 to October 2018) were identified from the trauma registry. Patients who received DVT screens earlier than one week or those that had superficial DVTs (eg peroneal or soleal clots) were excluded. Patients who developed PEs from this group were identified. The status of chemoprophylaxis (enoxaparin or heparin) was also noted.
Results: In the period studied, of over 20,000 trauma registry entries, there were120 patients noted to have positive Duplex ultrasound screens. After exclusions, 61 patients were included in the final analysis. (Males 77.0%) The mean age was 58.0 years (21.3). Three patients (7.3%) with a DVT proceeded to develop a PE. Forty patients (65.6%) had chemoprophylaxis ordered prior to DVT diagnosis. Of those 40 patients, 3 developed a PE. The average number of ventilator days for the cohort was 6.8 and the average number of operations per patient was 2.2. Only 7/61 (11.5%) patients had a history of prior clotting disorder.
Conclusion: Over a 70- month period, routine DVT screening at 1 week found thromboembolic events that required intervention that may otherwise not have been discovered. Some of these progressed to PE. Further evaluation of the practice of routine screening in asymptomatic trauma patient is needed.