Cs. Meyer et al., SURVEILLANCE VENOUS SCANS FOR DEEP VENOUS THROMBOSIS IN MULTIPLE TRAUMA PATIENTS, Annals of vascular surgery, 9(1), 1995, pp. 109-114
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 6
1 women whose average age was 38 years. All patients were treated prop
hylactically with either extremity pneumatic compression or subcutaneo
us heparin to prevent DVT. Most (87%) patients suffered blunt trauma a
nd had either head (3%), spinal (3%), intra-abdominal (9%), or lower e
xtremity (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 (99%) were normal, 16 (6%) were p
ositive 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 th
ose without symptoms (15% vs. 5%, p < 0.05). Patients with spinal inju
ries 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 expe
nse would be $300,000,000. Routine DVT surveillance is expensive and s
hould be reserved for symptomatic patients or those with spinal injuri
es.