INFERIOR VENA-CAVAL FILTER USE IN US TRAUMA CENTERS - A PRACTITIONER SURVEY

Questionnaires were mailed to 620 U.S. ''trauma surgeons'' to determin e a consensus regarding indications for inferior vena caval (IVC) filt er placement; 210 (34%) responded, Eighty-seven percent of respondents practiced in Level I trauma centers; 78% were in urban areas and 75% reported more than 1,000 trauma admissions per year. One-half (52%) of those responding were ''trauma directors'' at their centers. Filter i nsertion was done by radiologists at 81% of centers, by trauma surgeon s at 34%, by vascular surgeons at 33%, and by general surgeons at 13%, Each month, 60% of trauma centers inserted zero or one filter, wherea s 27% inserted two to three filters, Complications per year were repor ted as one or fewer in 85% of trauma centers, Respondents agreed that ''absolute indications'' for inserting NC filters were pulmonary embol ism while anticoagulated (93%), deep venous thrombosis present and ant icoagulation contraindicated (89%), and free-floating ileofemoral thro mbus by venogram (54%) and by duplex imaging (45%). ''Relative indicat ions'' for placement were deep venous thrombosis by duplex imaging (41 %) or by venogram (38%), spinal cord injury (40%), pelvic fractures (3 9%), multiple lower-extremity fractures (29%), concurrent cancer (19%) , prolonged bed rest (14%), and obesity (10%), The permanent nature of the filter affected its rate of application. For example, potential r emovability would significantly (p < 0.01) increase prophylactic place ment from 29 to 53% in the patient with multiple lower-extremity fract ures, Only 12% considered sepsis and 10% young age as contraindication s to IVC filter insertion, Contraindications and complications were fe w, yet frequency of use was surprisingly low, Radiologists insert the filter more than twice as often as surgeons.