Improved recovery of prophylactic inferior vena cava filters in trauma patients: the results of a dedicated filter registry and critical pathway for filter removal.
BACKGROUND
Temporary inferior vena cava filters (IVCF) are uniquely suited for trauma patients in whom the high risk of venous thromboembolism is transient. Currently, few "retrievable filters" are actually retrieved, with most published series documenting a retrieval rate between 20% and 50%. We sought to determine whether we could achieve a higher rate of retrieval with an improved process of care.


METHODS
All permanent and temporary filters were entered prospectively into a dedicated filter registry. Within 60 days of filter placement, all temporary filter patients were contacted by a trauma case manager to evaluate ongoing venous thromboembolism risk. Low-risk patients were then evaluated by radiology for removal of the IVCF. If appropriate, removal of the IVCF was scheduled. Initial contacts with patients were made by telephone. If unsuccessful with phone contact, family members, rehabilitation facility, and social work were all contacted to obtain the most recent phone number and address. A follow-up letter was sent to the patient with follow-up visit instructions. Finally, if prior contact measures did not work, a certified letter was sent to the last known address.


RESULTS
Between 2006 and 2009, of 7,949 trauma admissions, 420 (5.2%) met indications for filter placement. Of those, 160 were available for removal and 94 were successfully removed (59%).


CONCLUSIONS
A retrieval rate of 59% can be achieved with an explicit process of care emphasizing disciplined follow-up.


METHODS
III.
Division of Trauma/Critical Care, Lancaster General Hospital, 555 N. Duke Street, Lancaster, PA17602, USA. frogers2@lghealth.org
Frederick B
FB
Rogers
Steven R
SR
Shackford
Jo Ann
JA
Miller
Daniel
D
Wu
Amelia
A
Rogers
Angela
A
Gambler
D000293:Adolescent; D000328:Adult; D000368:Aged; D019091:Critical Pathways; D003697:Delphi Technique; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012042:Registries; D012307:Risk Factors; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior