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 ultrasound (US). Fifty-seven patients during an 8-month period met high-risk criteria for VT including age > 45 years, > 2 days bed rest, previous history of thromboembolism, spine fracture, coma, spinal cord injury, pelvic fracture, lower extremity injury, or femoral vein catheter. Doppler ultrasound showed 16 VTs in 12 patients. Venous thrombosis occurred despite prophylaxis (heparin or compression devices) in 9 of 12 patients. Iliac VT was noted in four patients, two of whom had no lower extremity VT. Upper extremity VT occurred in two patients who had received central venous catheters.


CONCLUSIONS
(1) US surveillance may be valuable in high-risk trauma patients because VT is a common finding (21%), despite prophylactic measures. (2) Examination of the upper extremity 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 duplex studies.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
G A
GA
Burns
S M
SM
Cohn
R J
RJ
Frumento
L C
LC
Degutis
L
L
Hammers
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000150:complications*