title: Duplex ultrasound screening detects high rates of deep vein thromboses in critically ill trauma patients.
abstract: OBJECTIVE
  American College of Chest Physician (ACCP) guidelines stratify deep venous thrombosis (DVT) risk in trauma patients based on injury pattern and pharmacologic prophylaxis. Screening is only recommended for patients with high-risk injuries who are unable to receive pharmacologic prophylaxis. However, the prevalence of lower extremity DVT (LEDVT) in trauma patients may be higher than reported in previous studies as many studies on DVT screening have not investigated calf vein DVTs (CVDVT) and have not exclusively targeted critically ill patients. Given that current ACCP guidelines recommend treatment of CVDVTs, we investigated the efficacy of duplex ultrasound (DUS) screening in critically ill trauma patients for all LEDVTs, including CVDVT, regardless of injury pattern, risk factors, or pharmacologic prophylaxis.
  
  
  METHODS
  Medical records of 264 intensive care unit trauma patients who received DUS screening for LEDVT were retrospectively examined for the presence of injuries conferring high risk for LEDVT, patient specific DVT risk factors, and low molecular weight heparin (LMWH) prophylaxis.
  
  
  RESULTS
  Forty (15.2%) patients had LEDVTs found on DUS screening, 24 (60%) were CVDVT, and 30% of all DVTs were diagnosed within 1 week of admission. Patients without high-risk injuries receiving LMWH had a 13.5% DVT rate, which did not differ significantly from the 19.7% DVT rate in high-risk injury patients not receiving LMWH (P = .667).
  
  
  CONCLUSIONS
  Lower extremity DVT is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, DVT risk factors, or pharmacologic prophylaxis. Previous studies have underestimated DVT rates by not investigating CVDVTs and not exclusively targeting critically ill patients. We recommend early and continued DUS DVT screening of all critically ill trauma patients.
authors.affiliation: Department of Surgery, Oregon Health and Sciences University, Portland, OR 97239, USA. azarbala@ohsu.edu
authors.forename: Amir
authors.initials: A
authors.lastname: Azarbal
authors.forename: Susan
authors.initials: S
authors.lastname: Rowell
authors.forename: Jason
authors.initials: J
authors.lastname: Lewis
authors.forename: Rakhee
authors.initials: R
authors.lastname: Urankar
authors.forename: Shannon
authors.initials: S
authors.lastname: Moseley
authors.forename: Gregory
authors.initials: G
authors.lastname: Landry
authors.forename: Greg
authors.initials: G
authors.lastname: Moneta
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009922:Oregon; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants