SCREENING FOR ASYMPTOMATIC DEEP-VEIN THROMBOSIS IN SURGICAL INTENSIVE-CARE PATIENTS

Purpose: To identify the presence of occult deep vein thrombosis (DVT) in surgical intensive care unit (SICU) patients and to avoid unnecess ary screening, we reviewed our experience with routine duplex screenin g for DVT in SICU patients. Methods: Over a 24-month period, all patie nts who were admitted to an SICU with an anticipated length of stay gr eater than 36 hours were studied to determine the prevalence of risk f actors for asymptomatic proximal DVT. Risk factors, demographics, and operative data were collected and analyzed with multilinear regression , t tests and chi(2) analysis. Results: There was a 7.5% prevalence of major DVT in the 294 patients studied. APACHE II scores (14.5 +/- 6.2 4 vs 10.3 +/- 3.15; p < 0.0001) and emergent procedures (45.5% vs 23.2 %; p > 0.0344) were associated with DVT by multifactorial analysis. Ag e was significant by univariate analysis. An algorithm based on the pr esence of any one of the three risk factors identified (APACHE II scor e 12 or more; emergent procedures; or age 65 or greater) could be used to limit screening by 30% while achieving a 95.5% sensitivity for ide ntification of proximal DVT. Conclusion: Absence of all three risk fac tors indicates a very low risk for DVT (1.1%), Screening of SICU patie nts is indicated because of a high prevalence of asymptomatic disease. Patients who have proximal DVT require active therapy and not prophyl axis, Costs and resources may be contained by using the above risk fac tors as a filter for duplex screening.