title: Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices.
abstract: BACKGROUND
  Many national agencies have suggested that deep vein thrombosis (DVT) rates measure quality of hospital care. However, none provide recommendations for standardized screening. If screening practices vary among clinicians or hospitals, DVT rates could be biased-centers which perform more duplex ultrasounds report more DVTs. We hypothesized that trauma surgeons have varying opinions regarding duplex ultrasound screening for DVT in asymptomatic trauma patients, which result in varying practice patterns.
  
  
  METHODS
  We conducted two web-based surveys regarding the use of duplex ultrasound screening for DVT in asymptomatic trauma patients. The first (individual provider level) surveyed members of two national trauma surgery organizations (American Association for the Surgery of Trauma and Eastern Association for the Surgery of Trauma). The second (trauma center level) surveyed practice patterns of National Trauma Data Bank hospitals.
  
  
  RESULTS
  Three hundred seventeen individual surgeons completed surveys. There was wide variation in individual opinions regarding DVT screening in asymptomatic trauma patients (53% agree, 36% disagree, and 11% neither agree nor disagree). Two hundred thirteen National Trauma Data Bank hospitals completed surveys of which 28% (n=60) have a written guideline regarding DVT screening in asymptomatic trauma patients. The proportion of centers with a written protocol varied significantly by trauma center level (p<0.001) but not by teaching status. Opinions and practice patterns suggest that screening should start early and be performed weekly. The main risk factors used to suggest DVT screening are spinal cord injury and pelvic fracture.
  
  
  CONCLUSIONS
  There are wide variations in trauma surgeons' opinions and trauma centers' practices regarding duplex ultrasound screening for DVT in asymptomatic trauma patients. This variability combined with the fact that performing more duplex ultrasounds finds more DVTs may influence reported DVT rates. DVT rates alone are biased and not reflective of true quality of trauma care.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ehaut1@jhmi.edu
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Neal
authors.forename: Christopher
authors.initials: C
authors.lastname: Hoeft
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
mesh_terms: D000328:Adult; D003625:Data Collection; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014194:Traumatology / Q000706:statistics & numerical data*; D018616:Ultrasonography, Doppler, Duplex / Q000706:statistics & numerical data*; D014481:United States; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging