Deep venous thrombosis: incidence on admission to a brain injury rehabilitation program.
OBJECTIVE
To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program.


METHODS
Prospective study, sequential case series.


METHODS
University tertiary care BI rehabilitation center.


METHODS
Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI.


METHODS
Evidence of intrinsic venous occlusion by duplex Doppler.


RESULTS
DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT.


CONCLUSIONS
The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.
Cifu
D X
DX
Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, USA.
Kaelin
D L
DL
Wall
B E
BE
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies; D012047:Rehabilitation Centers; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D018615:Ultrasonography, Doppler, Color
D000925:Anticoagulants