THE EFFICACY OF SEQUENTIAL COMPRESSION DEVICES IN MULTIPLE TRAUMA PATIENTS WITH SEVERE HEAD-INJURY

Thirty-two multiple trauma patients with severe head injury and a Glas gow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary em bolism (PE). All patients required mechanical ventilation. A sequentia l compression device (SCD) was used in 14 patients and 18 patients rec eived no prophylaxis for thromboembolism. Bilateral lower extremity te chnetium venoscans and ventilation/perfusion (V/Q) lung scans were per formed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days foll owing trauma. Twenty-five patients had normal or low probability V/Q s cans. Six had high probability V/Q scans confirmed by pulmonary arteri ograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, In jury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patients with DVT or PE. All but on e patient with DVT or PE underwent placement of a vena caval filter. M ultiple trauma patients with severe head injury (GCS score less-than-o r-equal-to 8) are at high risk for thromboembolism. The available mean s of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective.