title: Determining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System.
abstract: BACKGROUND
  This study aimed to determine the relative "weight" of risk factors known to be associated with venous thromboembolism (VTE) for patients with trauma based on injuries and comorbidities.
  
  
  METHODS
  A retrospective review of 16,608 consecutive admissions to a trauma center was performed. Patients were separated into those who developed VTE (n = 141) versus those who did not (16,467). Univariate analysis was performed for each risk factor reported in the trauma literature. Risk factors that were shown to be significant (p < 0.05) by univariate analysis underwent multivariate analysis to develop odds ratios for VTE. The Trauma Embolic Scoring System (TESS) was derived from the multivariate coefficients. The resulting TESS was compared with a data set from the National Trauma Data Bank (2002-2006) to determine its ability to predict VTE.
  
  
  RESULTS
  The multivariate analysis demonstrated that age, Injury Severity Score, obesity, ventilator use for more than 3 days, and lower-extremity trauma were significant predictors of VTE in our patient population. The TESS was from 0 to 14, with the best prediction for those patients with a score of more than 6 (sensitivity, 81.6%; specificity, 84%). Overall, the model had excellent discrimination in predicting VTE with a receiver operating characteristic curve of 0.89. The VTE rates for TESS in the National Trauma Data Bank data set were similar for all integers except for 3 and 4, in which the VTE rates were significantly higher (3, 0.2% vs. 0.6%; 4, 0.4% vs. 1.0%).
  
  
  CONCLUSIONS
  The TESS provides an objective measure of classifying VTE risk for patients with trauma. The TESS could allow informed decision making regarding prophylaxis strategies in patients with trauma.
authors.affiliation: Lancaster General Hospital, Lancaster, Pennsylvania 17602, USA. frogers2@lghealth.org
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
authors.forename: Steven R
authors.initials: SR
authors.lastname: Shackford
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horst
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Miller
authors.forename: Daniel
authors.initials: D
authors.lastname: Wu
authors.forename: Eric
authors.initials: E
authors.lastname: Bradburn
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Margaret
authors.initials: M
authors.lastname: Krasne
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003697:Delphi Technique; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000145:classification* / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy