The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis.
BACKGROUND
The identification of trauma patients at risk for the development of deep venous thrombosis (DVT) at the time of admission remains difficult. The purpose of this study is to validate the risk assessment profile (RAP) score to stratify patients for DVT prophylaxis.


METHODS
All patients admitted from November 1998 thru May 1999 were evaluated for enrollment. We prospectively assigned patients as low risk or high risk for DVT using the RAP score. High-risk patients received both pharmacologic and mechanical prophylaxis. Low-risk patients received none. Surveillance duplex Doppler scans were performed each week of hospitalization or if symptoms developed. Hospital charges for prophylaxis were used to determine the savings in the low-risk group. Statistical differences between the risk groups for each factor of the RAP and development of DVT were determined by the chi-squared test, with significance at a probability value of less than .05.


RESULTS
There were 102 high-risk (64%) and 58 low-risk (36%) individuals studied. Eleven of the high-risk group (10.8%) experienced the development of DVT (asymptomatic, 64%). None of the low-risk group was diagnosed with DVT. Five of the 16 RAP factors were statistically significant for DVT. Eliminating prophylaxis and Doppler scans in low-risk patients resulted in a total savings of $18,908 in hospital charges.


CONCLUSIONS
The RAP score correctly identified trauma patients at increased risk for the development of DVT. Despite prophylaxis, the high-risk group warrants surveillance scans. Withholding prophylaxis in low-risk patients can reduce hospital charges without risk.
Gearhart
M M
MM
Division of Trauma and Critical Care, the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Luchette
F A
FA
Proctor
M C
MC
Lutomski
D M
DM
Witsken
C
C
James
L
L
Davis
K
K
Johannigman
J A
JA
Hurst
J M
JM
Frame
S B
SB
D000328:Adult; D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D017046:Cost Savings; D006493:Heparin / Q000627:therapeutic use; D017721:Hospital Costs; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality*
D000925:Anticoagulants; D006493:Heparin