PROPHYLACTIC GREENFIELD FILTER PLACEMENT IN SELECTED HIGH-RISK TRAUMAPATIENTS

Purpose: Pulmonary embolus (PE) remains a major factor in morbidity an d death in severely injured patients, especially those in specific hig h-risk groups. PEs have been documented to occur despite routine deep venous thrombosis prophylaxis. The purpose of this study was to evalua te the safety and efficacy of prophylactic Greenfield filter (PGF) pla cement in patients who have multiple trauma with known high-risk injur ies for PE. Methods: From January 1992 to June 1994, PGF were prospect ively placed in 108 patients who had an injury severity score greater than 9 and met one of the following criteria: (1) severe head injury w ith prolonged ventilator dependence, (2) severe head injury with multi ple lower extremity fractures, (3) spinal cord injury with or without paralysis, (4) major abdominal or pelvic penetrating venous injury, (5 ) pelvic fracture with lower extremity fractures. These patients were compared with 216 patients, historically matched for age, sex, mechani sm of injury, injury severity score, and days in the intensive care un it. Data analysis was done with chi-squared and Student's t testing. R esult: There were no statistical differences between the PGF and contr ol group with regard to age (35.9 +/- 1.5 vs 38.3 +/- 1.4), sex (male 76% vs 75.5%), days in the intensive care unit (21.2 +/- 1.4 vs 18.1 /- 1.5), ISS (28.0 +/- 1.0 vs 25.4 +/- 0.8) and mechanism of injury (b lunt 85% vs 81%). None of the patients in the PGF group had a PE. In t he control group, however, 13 patients had a PE, nine of which were fa tal. These differences were statistically significant for both PE (P < 0.009) and PE-related death (p < 0.03). The overall mortality rate wa s reduced in the PGF group (18 of 108, 16%) versus the control group ( 47 of 216, 22%); however, this did not achieve statistical significanc e. Conclusion: PGF insertion in selected patients at high risk who had trauma effectively prevented both fatal and nonfatal PE. The lower in cidence of fatal PE in the PGE group may have contributed to a reducti on in the overall mortality rate. Patients who have trauma with high r isk for PE should be considered for PGE placement.