Abstract
The high reported incidence of deep venous thrombosis (DVT) in trauma patients has prompted surveillance venous duplex scanning of the lower extremities. We report our retrospective experience with 183 multiple trauma patients who were admitted to the surgical intensive care unit and underwent 261 surveillance venous scans. There were 122 men and 61 women whose average age was 38 years. All patients were treated prophylactically with either extremity pneumatic compression or subcutaneous heparin to prevent DVT. Most (87%) patients suffered blunt trauma and had either head (3%), spinal (3%), intra-abdominal (9%), or lower extremity (17%) injuries or a combination of injuries (68%). Almost two thirds of the patients had no symptoms suggestive of possible DVT. Of the 261 venous scans performed, 239 (92%) were normal, 16 (6%) were positive for proximal lower extremity DVT, and six (2%) showed thrombus limited to the calf veins. Patients with symptoms of lower extremity DVT were significantly more likely to have proximal DVT compared to those without symptoms (15% vs. 5%,p <0.05).Patients with spinal injuries also had a higher incidence of proximal DVT (18% vs. 6%,p <0.05).At current hospital charges, the cost to identify each proximal DVT was $6688. If surveillance duplex scans were performed on all trauma patients in the surgical intensive care unit, the national annual expense would be $300,000,000. Routine DVT surveillance is expensive and should be reserved for symptomatic patients or those with spinal injuries.
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References
Silver JR, Morris WR, Ostfinkowski JS. Associated injuries in patients with spinal injury. Injury 1980;12:219–224.
Brach B, Moser K, Cedar L, et al. Venous thrombosis in acute spinal paralysis. J Trauma 1977;17:289–293.
Shackford SR, Moser KM. Deep venous thrombosis and pulmonary embolism in trauma patients. J Intensive Care Med 1988;3:87–98.
Wheeler HB. Venous thromboembolism following trauma. J Intensive Care Med 1988;3:365–366.
National Institutes of Health Consensus Development Conference. Prevention of venous thrombosis and pulmonary embolism. JAMA 1986;256:744–749.
Sevitt S, Gallagher NG. Prevention of venous thrombosis and pulmonary embolism in injured patients. Lancet 1959, 2:981–989.
Barnes RW, Nix ML, Barnes CL, et al. Perioperative asymptomatic venous thrombosis: Role of duplex scanning versus venography. J Vasc Surg 1989;9:251–260.
Lensing AWA, Prandonia P, Brandjes PM, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989;320:342–345.
Patterson RB, Fowl RJ, Keller JD, et al. The limitations of impedance plethysmography in the diagnosis of acute deep venous thrombosis. J Vasc Surg 1989;9:725–729.
Hamilton SM. Coalition on trauma-prevention and trauma care: Presidential address to the Trauma Association of Canada. J Trauma 1991;31:951–957.
Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism: A clinico-pathological study in injured and burned patients. Br J Surg 1961;48:475–489.
Freeark RJ, Boswick J, Fardin R. Post-traumatic venous thrombosis. Arch Surg 1967;95:567–575.
Kudsk KA, Fabian TC, Baum S, et al. Silent deep vein thrombosis in immobilized multiple trauma patients. Am J Surg 1989;158:515–519.
Kerr TM, Cranley JJ, Johnson JR, et al. Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning. Surgery 1990;108: 520–527.
Markel A, Manzo RA, Bergelin RO, et al. Pattern and distribution of thrombi in acute venous thrombosis. Arch Surg 1992;127:305–309.
Waring WP, Karunas RS. Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease. Paraplegia 1991;29:8–16.
Myllynen P, Kammonen M, Rukkanen P. Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: A comparison with nonparalysed patients immobilized due to spinal fractures. J Trauma 1985;25:541–543.
Hull RD, Raskob GE, Hirsh J. Prophylaxis of venous thromboembolism. An overview. Chest 1986;89(Suppl):374S-383S.
Kakker VV, Corrigan TP, Fossard DP. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet 1975;2:45–51.
Clagett GP, Reish JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 1988;208:227–240.
Nicolaides AN, Fernandes EF, Pollack AV. Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis. Surgery 1980;87:69–75.
Shackford SR, Davis JW, Hollingsworth-Fridlund P, et al. Venous thrombosis in patients with major trauma. Am J Surg 1990;159:365–369.
Gunduz S, Ogur E, Mohur H, et al. Deep vein thrombosis in spinal cord injured patients. Paraplegia 1993;31:606–610.
Comerota AJ, Katz ML, Hashemi HA. Venous duplex imaging for the diagnosis of acute deep venous thrombosis. Haemostasis 1993;23(Suppl):61–71.
Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: Establishing national norms for trauma care. J Trauma 1990;30:1356–1365.
Hillner BE, Philbrick JT, Becker DM. Optimal management of suspected lower-extremity deep venous thrombosis: An evaluation with cost assessment of 24 management strategies. Arch Intern Med 1992;152:165–175.
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Meyer, C.S., Blebea, J., Davis, K. et al. Surveillance venous scans for deep venous thrombosis in multiple trauma patients. Annals of Vascular Surgery 9, 109–114 (1995). https://doi.org/10.1007/BF02015324
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DOI: https://doi.org/10.1007/BF02015324