IS DEEP-VEIN THROMBOSIS SURVEILLANCE WARRANTED IN HIGH-RISK TRAUMA PATIENTS

BACKGROUND: Deep vein thrombosis (DVT) has been reported to occur in 2 0% to 40% of high-risk trauma patients if no prophylaxis is used, The purpose of this study was to determine the incidence of DVT and utilit y of a screening program in a high-risk group of trauma patients for w hom routine DVT prophylaxis was utilized. PATIENTS AND METHODS: Of 3,1 54 trauma admissions over a 20-month period, 343 patients (10.9%) iden tified as high risk based on established criteria (prolonged bed rest, Glasgow coma score (GCS) of 7, spinal injury, lower extremity or pelv ic fracture) were placed on a prospective surveillance protocol using color-flow duplex scanning and received thromboembolic prophylaxis. RE SULTS: Twenty-three thromboembolic complications occurred, including 2 0 DVTs (5.8%) and 3 pulmonary emboli ([PE] 1%), Univariate analysis sh owed that the risk of DVT was related to age (52.6 + 19.9 years versus 38.1 + 18.5; P = 0.001), a longer hospital stay (31.4 versus 17.8 day s; P = 0.001), or the presence of spinal fracture (12.6% versus 3.5%; P = 0.01), Discriminant function analysis revealed that length of stay , intensive care unit days, age, and GCS allowed correct classificatio n of those who did not develop DVT in 97% of cases but was only correc t in 15% of cases in predicting those who would develop DVT, Injury se verity score (ISS) was not predictive in this multivariate analysis, S eventeen (85%) DVTs were unsuspected clinically, Study patients receiv ed an average of 3.5 studies at an overall charge of $313,330 to detec t 17 clinically unsuspected DVTs (5%), This represents about 5% of the total bed charges for these patients, or $18,000 per DVT. CONCLUSIONS : These results suggest that standard use of DVT prophylaxis in a high -risk trauma population leads to a low incidence of DVT and that a scr eening protocol is effective in detecting unsuspected DVTs, Use of a s urveillance protocol, however, may reduce but will not eliminate the i ncidence of pulmonary emboli in this patient population.