ROUTINE PROPHYLACTIC VENA-CAVA FILTER INSERTION IN SEVERELY INJURED TRAUMA PATIENTS DECREASES IN INCIDENCE OF PULMONARY-EMBOLISM

BACKGROUND: Trauma patients are at increased risk for venous thromboem bolism despite routine prophylaxis. A five-year retrospective review o f pulmonary embolism at the Medical Center Hospital of Vermont showed that four types of injuries (head injuries, spinal cord injuries, comp lex pelvic fractures, and hip fractures) accounted for 92 percent of p ulmonary emboli in patients on the trauma service. STUDY DESIGN: Begin ning July 1991, all patients who met criteria for a high-risk injury ( excluding hip fractures) had prophylactic vena cava filters inserted p ercutaneously in the radiology suite. Weekly impedance plethysmography was performed for the detection of deep vein thrombosis. Following di scharge, abdominal duplex ultrasound was performed at one month, six m onths, and yearly to check filter position and patency. RESULTS: To da te, a total of 63 patients, or 2 percent of the total trauma populatio n, had prophylactic vena cava filters inserted. There were 19 (30 perc ent) deep vein thromboses in this population of patients and one patie nt had a pulmonary embolism (1.5 percent). Overall there was significa nt (chi-square, p<0.00072) reduction of pulmonary embolism on the trau ma service compared to the historical controls. Follow-up examination with abdominal duplex ultrasound showed a 30-day patency rate of 100 p ercent and a one- and two-year patency rate of 96.1+/-3.8 percent by l ife-table analysis. CONCLUSIONS: We conclude that prophylactic vena ca va filters are efficacious in decreasing the risk of pulmonary embolis m in high-risk trauma patients.