Venous thromboembolism in the elderly: the result of comorbid conditions or a consequence of injury?
BACKGROUND
Venous thromboembolism (VTE) is a common complication in trauma patients. Several risk factors have been identified that may place patients at in increased risk for VTE including preexisting medical conditions, iatrogenic factors, and injury-related factors. Advanced age has also been implicated as a risk factor for VTE. The purpose of this study was to determine the incidence and outcomes of VTE in geriatric trauma patients as well as to identify risk factors for VTE in this population.


METHODS
We performed a 10-year retrospective review of all trauma patients aged 65 years or older discharged with a diagnosis of VTE. Demographic data, injuries, mechanism, Injury Severity Score, Abbreviated Injury Score, Glasgow Coma Scale, length of stay, and mortality were collected.


RESULTS
: Of 2,521 trauma patients aged 65 years or older, 82 (3.2%) were diagnosed with VTE. Seventy-two of 82 patients were diagnosed with deep vein thrombosis, and pulmonary embolism was found in 8 patients. Two patients had both a deep vein thrombosis and pulmonary embolism. Independent predictors of VTE included traumatic brain injury (p < 0.05); chest Abbreviated Injury Score ≥ 3 (p < 0.001); mechanical ventilation (p < 0.001); major operation (p < 0.001); and history of VTE (p = 0.05). Other comorbid conditions were not significantly associated with VTE. Preinjury anticoagulation had a trend toward a protective effect. Although length of stay was longer in patients with VTE (adjusted mean difference 14.7 days, p < 0.001), mortality for patients with and without VTE was 8.5% and 7.0%, respectively (p = 0.59).


CONCLUSIONS
VTE is associated with prolonged length of stay and duration of mechanical ventilation as well as continued medical dependence after discharge. Several risk factors place the elderly trauma patient at an increased risk for VTE, and trauma or injury-related risk factors seem to have a greater impact on the development of VTE in comparison to underlying conditions or increasing patient age (>65 years).


METHODS
II, prognostic study.
Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego Medical Center, San Diego, California 92103-8896, USA.
Dennis Y
DY
Kim
Leslie
L
Kobayashi
Galinos
G
Barmparas
Dale
D
Fortlage
Terry
T
Curry
Raul
R
Coimbra
D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology*