THE ROLE OF ULTRASONOGRAPHY AND INFERIOR VENA-CAVA FILTER PLACEMENT IN HIGH-RISK TRAUMA PATIENTS

Undetected lower-extremity deep-vein thrombosis (LEDVT) in the trauma patient can lead to significant morbidity and mortality. The purpose o f this study was to: 1) evaluate the role of ultrasonography in the ea rly detection of LEDVT in high-risk trauma patients; 2) identify progn ostic indicators that predict LEDVT; and 3) evaluate the efficacy of s elected inferior vena cava (IVC) filter placement in the prevention of pulmonary emboli. From October 1993 through December 1994, all adult multiple-trauma patients admitted to the Trauma Service who required p rolonged bed rest (> 3 days) or sustained a lower-extremity, pelvic, o r spinal fracture with paralysis were prospectively studied with seria l physical examinations and lower-extremity venous ultrasounds within 72 hours of admission and then weekly until discharge. Two hundred twe nty-eight patients were entered into the study. Thirty-nine patients ( 17%) developed ultrasound evidence of LEDVT; of these, only seven (18% ) were evident on physical examination. This allowed 32 patients (82%) with unsuspected LEDVT to receive earlier definitive therapy. Multiva riate logistic regression analysis of LEDVT with various predictors fo und age, hospital length of stay, and lower-extremity trauma to be sig nificant predictors of LEDVT (P < 0.05). Twenty-nine patients (74%) ha d immediate IVC filter placement upon ultrasound identification of pro ximal LEDVT. None of these patients developed pulmonary emboli. Ten pa tients (26%) with a LEDVT were treated with systemic anticoagulation a lone. One of these patients sustained a fatal pulmonary embolus. In a historic control group of 234 high-risk trauma patients admitted in th e 14 months prior to implementing screening ultrasounds, six patients sustained pulmonary emboli (P < 0.05). Screening ultrasounds combined with selective placement of IVC filters play an important role in redu cing the morbidity and mortality associated with LEDVT in high-risk tr auma patients.