COMPARISON OF SEQUENTIAL COMPRESSION DEVICES AND FOOT PUMPS FOR PROPHYLAXIS OF DEEP VENOUS THROMBOSIS IN HIGH-RISK TRAUMA PATIENTS

Multiple-trauma patients are at increased risk for deep venous thrombo sis (DVT) but are also at increased risk of bleeding, and the use of h eparin may be contraindicated. Sequential pneumatic compression device s (SCDs) are an alternative for DVT prophylaxis. However, lower extrem ity fracture or soft tissue injury may preclude their use. In these ci rcumstances, foot pumps (FPs) are often substituted, yet little clinic al data exist to support their use. We identified 184 consecutive high -risk trauma patients who received DVT prophylaxis with compression de vices. We reviewed demographic data, mechanism of injury, Injury Sever ity Score, injury pattern, and method of prophylaxis. Generally, SCDs were preferred, but FPs were substituted in patients with lower extrem ity injuries. Occurrences of DVT or pulmonary embolism were also noted . Patients surviving less than 48 hours were excluded. SCDs were used in 118 patients (64%) and FPs in 66 patients (34%). There were no diff erences in age, Injury Severity Score, or presence of shock on admissi on. As expected, FP patients were more likely to have lower extremity fractures (65 vs 26%; P < 0.05) and were also more likely to have asso ciated pelvic fracture (59 vs 25%; P < 0.05) and chest injury (61 vs 2 6%, P < 0.05). There was no difference in the incidence of head injury , although SCD patients had more severe head injuries (Glasgow Coma Sc ore, 7.9 vs 10.5; P < 0.05). The overall incidence of DVT was 5.4 per cent (10 of 184), with no differences between the two groups (SCD 7% v s FP 3%). Three patients had a pulmonary embolism (FP, two; SCD, one), none of which were fatal. Compression devices provide adequate DVT pr ophylaxis with a low failure rate (3-8%) and no device-related complic ations. FPs appear to be a reasonable alternative in the high-risk tra uma patient when lower extremity fractures precludes use of SCD.