PROPHYLACTIC VENA-CAVA FILTER INSERTION IN SEVERELY INJURED TRAUMA PATIENTS - INDICATIONS AND PRELIMINARY-RESULTS

Pulmonary embolism (PE) remains a significant problem in trauma patien ts. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma, patients (1% incidence). Three groups of high -risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of P E in these high-risk patients was 21 to 54 times that of the general t rauma population. Beginning in July 1991, as prophylaxis against PE, v ena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted per cutaneously in the radiology suite without complications. On follow-up examination, 17.6% developed documented lower extremity deep vein thr ombosis. There were no PEs. Overall, the incidence of PE in the genera l trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi2). We conclude that insertion of VCFs in high-risk trauma pa tients is safe and efficacious in decreasing the incidence of PE.