Thermally injured patients are at significant risk for thromboembolic complications

Background: The incidence of thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) in thermally injured patients is considered sufficiently uncommon that routine prophylactic measures are not warranted. Nevertheless, the incidence of DVT/PE may be increasing. Methods: The records of 1,300 patients admitted to our unit from January 19 90 to June 1995 were reviewed. Results: Twenty-three patients developed a clinically significant DVT, eigh t patients developed a PE, and two patients developed both a DVT and a PE, for an overall DVT/PE incidence of 2,9%, Four of 10 PEs were felt to be fat al. The DVT/PE patients were older (mean age, 42.6 vs. 28.7; p < 0.001) and had larger burns (37% vs. 18%, p < 0.001) than patients without evidence o f DVT/PE. Body weight appeared to also influence DVT/PE rates,,with obese p atients (>30% over ideal body weight) having a higher incidence than patien ts with low or normal body weight (7.2 vs. 2,7%, p < 0,015). Age and total body surface area (TBSA) burn had a synergistic effect on DVT/PE risk, with the sum of age and TBSA burn exerting the strongest independent effect whe n discriminant function analysis was performed (p < 0.001). Conclusion: One can identify a population at increased risk of DVT/PE on th e basis of the sum of age and TBSA burn, but prospective screening trials t hat assess all risk factors for DVT/PE should be performed before routine p rophylaxis is used in thermally injured patients.