title: Is upper extremity trauma an independent risk factor for lower extremity venous thromboembolism? An 11-year experience at a Level I trauma center.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is an important problem in orthopedic trauma patients. An association between VTE and upper extremity injury has not been reported. The purpose of this investigation was to determine whether upper extremity trauma is an independent risk factor for lower extremity VTE. This study also attempted to identify associations between VTEs and demographic and injury variables in patients that sustained upper extremity trauma.
  
  
  METHODS
  Eleven years of data from the trauma registry at our Level I trauma center was retrospectively reviewed in an injury-matched cohort study. From an initial pool of 646 patients who sustained upper extremity trauma, 32 subjects (4.95%) were identified as having major upper extremity injuries as well as thromboembolic complications. Thirty-two injury-matched controls were randomly selected from the 646 patients with major upper extremity injuries. Regression analysis was performed to determine variables that were significantly associated with lower extremity thromboembolic complications.
  
  
  RESULTS
  Overall incidence of VTE in patients sustaining upper extremity injury was 4.95% (deep vein thrombus 4.64%, pulmonary embolism 0.31%) and was similar to the 4.95% VTE rate in patients without upper extremity injury. Major head injury (p = 0.022) occurred at increased frequency in the VTE group. Patients with increased length of hospital stay (p < 0.001) and length of time on a ventilator (p = 0.002) were at significantly higher risk for thromboembolic complications. No patient with isolated upper extremity trauma had complications from VTE.
  
  
  CONCLUSIONS
  Lower extremity VTE occurs at similar rates in patients sustaining upper extremity injury compared to those patients that do not. Major upper extremity orthopedic trauma is not an independent risk factor for lower extremity VTE, and current clinical management guidelines for VTE prophylaxis are adequate for patients sustaining major upper extremity trauma.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce, 2nd Floor, Silverstein Building, Philadelphia, PA 19104, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Hsu
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
authors.forename: John L
authors.initials: JL
authors.lastname: Esterhai
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D034941:Upper Extremity / Q000293:injuries*; D054556:Venous Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000517:prevention & control; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*