PROSPECTIVE ULTRASOUND EVALUATION OF VENOUS THROMBOSIS IN HIGH-RISK TRAUMA PATIENTS

To determine the incidence of venous thrombosis (VT), high-risk trauma patients were evaluated prospectively biweekly with Doppler ultrasoun d (US). Fifty-seven patients during an 8-month period met high-risk cr iteria for VT including age >45 years, >2 days bed rest, previous hist ory of thromboembolism, spine fracture, coma, spinal cord injury, pelv ic fracture, lower extremity injury, or femoral vein catheter. Doppler ultrasound showed 16 VTs in 12 patients. Venous thrombosis occurred d espite prophylaxis (heparin or compression devices) in 9 of 12 patient s. Iliac VT was noted in four patients, two of whom had no lower extre mity VT. Upper extremity VT occurred in two patients who had received central venous catheters. Conclusions: (1) US surveillance may be valu able in high-risk trauma patients because VT is a common finding (21%) , despite prophylactic measures. (2) Examination of the upper extremit y and pelvic venous system appears to be important, since 33% (4 of 12 ) of our patients with VT developed thrombi isolated to these regions. These would not have been identified during routine lower extremity d uplex studies.