Prevention of pulmonary embolism by combined modalities of thromboprophylaxis and intensive surveillance protocol.
OBJECTIVE
Deep vein thrombosis (DVT) is a known complication in neurosurgical patients. The protocols for the prevention of DVT and pulmonary embolism (PE) are not applied universally. Our goal was to review the incidence of DVT and PE in neurosurgical intensive care units (NSICUs) and to compare it with the incidence of DVT and PE in other intensive care units (ICUs) in the same hospital.


METHODS
We retrospectively reviewed 5327 consecutive admissions in all intensive care units at the University of Illinois Hospital between July 2001 and June 2002. The NSICU had 1094 admissions, and all other ICUs combined had 4233 admissions. In our NSICU, every patient was administered DVT prophylaxis in the form of subcutaneous heparin and a sequential compression device if these treatments were not contraindicated. Lower-extremity venous Doppler ultrasonography was performed twice weekly in all NSICU patients. There was no routine use of DVT prophylaxis in the other ICUs, and no other ICUs performed routine lower-extremity venous Doppler ultrasonography. We compared the incidence of DVT and PE in the NSICU and the combined population of other adult ICUs.


RESULTS
PE was diagnosed in 1 (0.09%) of 1094 patients in the NSICU and in 45 (1.06%) of 4233 patients in all other ICUs (P < 0.0001, Z = 5.34). DVT was diagnosed in 28 patients (2.55%) in the NSICU and in 238 patients (5.62%) in all other ICUs (P < 0.001, Z = 4.32). These values suggest a statistically significant difference in the incidence of DVT and PE in the NSICU compared with all other ICUs.


CONCLUSIONS
We conclude that there was a significantly lower incidence of DVT and PE in the NSICU than in all other ICUs at our institution. DVT prophylaxis and twice-weekly lower-extremity venous Doppler screening in the NSICU have been found to be beneficial in decreasing the incidence of DVT and particularly effective in preventing PE.
Misra
Mukesh
M
Department of Neurosurgery, University of Illinois, Chicago, Illinois 60612, USA.
Roitberg
Ben
B
Ebersole
Koji
K
Charbel
Fady T
FT
D000328:Adult; D001458:Bandages; D003131:Combined Modality Therapy / Q000379:methods; D003422:Critical Care / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006493:Heparin