Author:
Cobler-Lichter Michael D.,Collie Brianna L.,Delamater Jessica M.,Shagabayeva Larisa,Lyons Nicole B.,Bustillos Luciana Tito,Namias Nicholas,Stallings Jonathan D.,Gross Kirby R.,Buzzelli Mark D.,Gurney Jennifer,Proctor Kenneth G.,Wetstein Paul J.
Abstract
BACKGROUND
Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population.
METHODS
Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2. All deaths were excluded in subsequent analysis. Rates of VTE were assessed, and subgroup analysis was performed on patients requiring massive transfusion.
RESULTS
Department of Defense Trauma Registry (n = 288) patients were young (mean age, 25 years) and predominantly male (98%) with severe (mean Injury Severity Score, 26), mostly penetrating injury (76%) and high mortality. Venous thromboembolism rate was high: 15.8% (DVT, 10.3%; pulmonary embolism, 7.1%). In the massively transfused population, the VTE rate was even higher (26.7% vs. 10.2%, p < 0.001).
CONCLUSION
This is the first report that combat casualties requiring damage-control laparotomy at R2 have such high VTE rates. Therefore, for military casualties, we propose screening ultrasound upon arrival to each subsequent capable echelon of care and low threshold for initiating thromboprophylaxis.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Publisher
Ovid Technologies (Wolters Kluwer Health)