Venous thromboembolic disease in trauma and surveillance ultrasonography

Randeep S. Jawa, Kathy Warren, David Young, Michel Wagner, Lawrence Nelson, Diane Yetter, Shane Banks, Valerie Shostrom, Joseph Stothert

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. Materials and Methods: We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. Results: We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Conclusions: Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings.

Original languageEnglish (US)
Pages (from-to)24-31
Number of pages8
JournalJournal of Surgical Research
Volume167
Issue number1
DOIs
StatePublished - May 1 2011

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Keywords

  • DVT
  • PE
  • duplex
  • embolism
  • pulmonary
  • surveillance
  • thrombus
  • trauma
  • ultrasound
  • venous

ASJC Scopus subject areas

  • Surgery

Cite this

Jawa, R. S., Warren, K., Young, D., Wagner, M., Nelson, L., Yetter, D., Banks, S., Shostrom, V., & Stothert, J. (2011). Venous thromboembolic disease in trauma and surveillance ultrasonography. Journal of Surgical Research, 167(1), 24-31. https://doi.org/10.1016/j.jss.2010.09.046