title: Venous thromboembolic disease in trauma and surveillance ultrasonography.
abstract: BACKGROUND
  The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates.
  
  
  METHODS
  We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service.
  
  
  RESULTS
  We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT.
  
  
  CONCLUSIONS
  Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-3280, USA. rjawa@unmc.edu
authors.forename: Randeep S
authors.initials: RS
authors.lastname: Jawa
authors.forename: Kathy
authors.initials: K
authors.lastname: Warren
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.forename: Michel
authors.initials: M
authors.lastname: Wagner
authors.forename: Lawrence
authors.initials: L
authors.lastname: Nelson
authors.forename: Diane
authors.initials: D
authors.lastname: Yetter
authors.forename: Shane
authors.initials: S
authors.lastname: Banks
authors.forename: Valerie
authors.initials: V
authors.lastname: Shostrom
authors.forename: Joseph
authors.initials: J
authors.lastname: Stothert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D035002:Lower Extremity / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult