title: Surveillance and Early Management of Deep Vein Thrombosis Decreases Rate of Pulmonary Embolism in High-Risk Trauma Patients.
abstract: BACKGROUND
  Venous duplex ultrasound (VDU) is the modality of choice for surveillance of venous thromboembolism (VTE), but there is controversy about its appropriate implementation as a screening method. We hypothesize that VDU surveillance in trauma patients at high risk for VTE decreases the rate of pulmonary embolism (PE).
  
  
  METHODS
  One thousand two hundred and eighty-two trauma ICU admissions were screened with Greenfield's Risk Assessment Profile from August 2011 to September 2014. Four hundred and two patients were identified as high risk for VTE (Risk Assessment Profile ≥10). Those who received weekly VDU to evaluate for deep vein thrombosis (n = 259 [64%]) were compared with those who did not (n = 143 [36%]). Parametric data are reported as mean ± SD and nonparametric data are reported as median (interquartile range). Statistical significance was determined at an α level of 0.05.
  
  
  RESULTS
  The overall study population was 47 ± 19 years old and 75% were male, 78% of injuries were blunt mechanism, Injury Severity Score was 28 ± 13, Risk Assessment Profile was 14 ± 4, and mortality was 14.3%. Deep vein thrombosis rate was 11.6% (n = 30) in the surveillance group vs 2.1% (n = 3) in the non-surveillance group (p < 0.001). Deep vein thromboses detected in the surveillance group were managed with systemic anticoagulation (43%) or with IVC filter placement (57%). In the surveillance group, the PE rate was 1.9% (n = 5) vs 7.0% (n = 10) in the non-surveillance group (p = 0.014).
  
  
  CONCLUSIONS
  Trauma patients at high risk for VTE and who received VDU surveillance and early management of deep vein thrombosis have decreased rates of pulmonary embolism.
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Clark R
authors.initials: CR
authors.lastname: Murray
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ginzburg
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Lineen
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, FL. Electronic address: kproctor@miami.edu.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D000925:Anticoagulants