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Analysis of venous thromboembolism in neurosurgical patients undergoing standard versus routine ultrasonography

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Abstract

Routine screening of high-risk asymptomatic trauma or surgical patients for venous thromboembolism (VTE) is controversial. Studies suggest against screening while others recognize that some patients at high risk may benefit. The purpose of this pilot study is to evaluate the benefit of routine screening using doppler ultrasonography for the early detection of deep venous thrombosis (DVT) in post-operative neurosurgical patients. This was a quasi-experimental study at a major academic tertiary care medical center. A total of 157 adults underwent cranial or spinal surgical interventions from March through August 2017 and received either standard screening (n = 104) versus routine ultrasonography screening (n = 53). There was no significant difference in incidence of DVT between the two groups: 11 (11%) in the standard screening group versus 5 (9%) in the routine screening group, p = 0.823. Upper and lower extremity ultrasonography was performed in 43 (41%) of the standard screening group versus 53 (100%) in the routine screening group, p < 0.001. DVT was identified in nearly one of every 6 ultrasonography screenings in the standard screening group versus 27 ultrasonography screenings required to identify one DVT in the routine screening group. There were the same number of screenings for upper extremity ultrasonography, but they did not yield or detect DVT; instead only superficial, untreatable, DVTs were reported. Total cost to diagnose one DVT, including screening and labor, averaged $13,664 in the standard group versus $56,525 in the routine group. Routine screening in neurosurgical patients who received VTE prophylaxis was not associated with lower incidence of VTE and mortality attributed to PE. Thus, routine screening may not be cost effective to prevent complications from DVT incidence.

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Acknowledgements

We thank the director, Dr. H. Alex Choi, MD for allowing the study to be performed in the NSICU.

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Authors and Affiliations

  1. Neuroscience Intensive Care Unit, Department of Pharmacy, Memorial Hermann - Texas Medical Center, 6411 Fannin Street, Houston, TX, 77054, USA

    Sophie Samuel & Thuy Nguyen

  2. Department of Critical Care Medicine, Memorial Regional Hospital, Hollywood, FL, USA

    Niral Patel

  3. Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, Houston, USA

    Mary F. McGuire

  4. Department of Pharmacy, Baylor College of Medicine, Houston, TX, USA

    Miguel Salazar

Authors
  1. Sophie Samuel
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  2. Niral Patel
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  3. Mary F. McGuire
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  4. Miguel Salazar
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  5. Thuy Nguyen
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Contributions

SS: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content. NP: analysis and interpretation, critical revision of the manuscript for important intellectual content. MM: analysis and interpretation, critical revision of the manuscript for important intellectual content. MS: analysis and interpretation, critical revision of the manuscript for important intellectual content. TN: analysis and interpretation, critical revision of the manuscript for important intellectual content.

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Correspondence to Sophie Samuel.

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Samuel, S., Patel, N., McGuire, M.F. et al. Analysis of venous thromboembolism in neurosurgical patients undergoing standard versus routine ultrasonography. J Thromb Thrombolysis 47, 209–215 (2019). https://doi.org/10.1007/s11239-018-1761-8

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  • DOI: https://doi.org/10.1007/s11239-018-1761-8

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