title: Deep vein thrombosis screening and risk factors in a high-risk trauma population.
abstract: BACKGROUND
  Trauma patients requiring acute inpatient rehabilitation are significantly injured, with increased risk for deep vein thrombosis (DVT). We evaluated routine screening for occult DVT in such patients, and analyzed DVT risk factors.
  
  
  METHODS
  Data from level I trauma center patients discharged to a single acute rehabilitation center (ARC) from 2007-2011 were retrospectively reviewed. Routine lower extremity duplex was performed on ARC admission. Follow-up data were collected for patients with occult DVT (ARC DVT). DVT predictors were evaluated using logistic regression.
  
  
  RESULTS
  Of 622 patients, 534 (86%) had screening duplex; 26 (4.8%) had an ARC DVT. A majority of 442 patients (71%) received enoxaparin prophylaxis in hospital, for a median 64% of hospital days. Of ARC DVT patients, 17 received full anticoagulation and 16 received vena cava filters. Thirty-seven patients had DVT diagnosed in the hospital (hospital DVT) before discharge to ARC. Hospital DVT and ARC DVT groups were comparable except shorter median hospital length of stay and lower head abbreviated injury scale in ARC DVT patients. On multivariate analysis, increased intensive care unit length of stay, age >65 y, a lower percentage of hospital days receiving chemoprophylaxis, and delayed initiation of chemoprophylaxis were significantly predictive of DVT after adjustment for sex, mechanism, injury severity score, and admission systolic blood pressure. Presence of pelvic fractures and ages 50-65 y also posed an increased risk.
  
  
  CONCLUSIONS
  The incidence of occult DVT on ARC admission is low in trauma patients. Several risk factors for DVT in the trauma ARC population were identified. Nonselective screening of all trauma patients on admission to ARC is not supported by this analysis.
authors.affiliation: Department of Surgery, Trauma Services, Inova Fairfax Hospital, Falls Church, VA. Electronic address: christopher.michetti@inova.org.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Michetti
authors.affiliation: Department of Surgery, Trauma Services, Inova Fairfax Hospital, Falls Church, VA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Franco
authors.affiliation: Department of Surgery, Trauma Services, Inova Fairfax Hospital, Falls Church, VA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coleman
authors.affiliation: Department of Surgery, Trauma Services, Inova Fairfax Hospital, Falls Church, VA.
authors.forename: Anna
authors.initials: A
authors.lastname: Bradford
authors.affiliation: Department of Surgery, Trauma Services, Inova Fairfax Hospital, Falls Church, VA.
authors.forename: Amber W
authors.initials: AW
authors.lastname: Trickey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014768:Virginia / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications*
keywords: Acute rehabilitation; DVT; Enoxaparin chemoprophylaxis; Risk factors; Screening; Trauma