Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem?

Author:

Stawicki Stanislaw P.1,Grossman Michael D.2,Cipolla James2,Hoff William S.2,Hoey Brian A.2,Wainwright Gail2,Reed James F.3

Affiliation:

1. Department of Surgery, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania;

2. Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania

3. Research Institute, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania

Abstract

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.

Publisher

SAGE Publications

Subject

General Medicine

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