Deep venous thrombosis and pulmonary embolism in trauma patients: an overstatement of the problem?

• Published in: The American surgeon Vol. 71; no. 5; p. 387
• Main Authors: Stawicki, Stanislaw P, Grossman, Michael D, Cipolla, James, Hoff, William S, Hoey, Brian A, Wainwright, Gail, Reed, 3rd, James F
• Format: Journal Article
• Language: English
• Published: United States 01-05-2005
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Pennsylvania - epidemiology; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Retrospective Studies; Risk Factors; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; Wounds and Injuries - complications; Wounds and Injuries - epidemiology; Pennsylvania
• ISSN: 0003-1348
• DOI: 10.1177/000313480507100504

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 > or =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 > or =5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.