title: Symptomatic venous thromboembolism in Asian major trauma patients: incidence, presentation and risk factors.
abstract: BACKGROUND
  Trauma patients are known to be at increased risk of venous thromboembolism (VTE), and pulmonary embolism (PE) is one of the preventable causes of mortality in trauma patients. The incidence of VTE in Asian populations was believed to be lower than in Caucasians, but the recent literature suggests that this is not the case. The purpose of this study was to assess the incidence of VTE in Asian major trauma patients and to examine the manner of presentation, use of prophylaxis and risk factors for VTE. While other studies of VTE have addressed general and high-risk populations within Asia, our study is one of the few to examine Asian major trauma patients.
  
  
  METHODS
  Data for all patients with VTE were extracted from the Singapore General Hospital trauma database over a 10-year period from 1998 to 2007. Patient profiles and clinical factors were compared to patients without a diagnosis of VTE admitted with injuries in the same time period.
  
  
  RESULTS
  There were 8,615 patients entered into our database in this 10-year period. Thirty-four patients had VTE, with an overall incidence of 0.39 %. Thirteen patients had pulmonary embolism, an incidence of 0.15 %. Of note, 30 % of patients with deep vein thrombosis (DVT) presented with fever alone without limb symptoms. Almost all 34 patients who developed VTE had either head injury, a spinal cord injury or a pelvic/extremity injury. Eighteen patients had head injury, 22 patients sustained pelvic or extremity injury, and three patients had spinal cord injury with paraplegia. Head injury and spinal cord injury with neurologic sequelae were statistically significant risk factors for VTE (p < 0.05).
  
  
  CONCLUSIONS
  The incidence of symptomatic VTE in the Asian trauma population is no lower than in the West. The incidence found in this study is similar to the incidence of VTE according to a study using data from the American national trauma data bank using similar study methods and with a similar study population. It is also higher than the incidence in the literature for general post-surgical Asian patients. Fever was the presenting factor in some patients and screening for VTE should not be forgotten when assessing fever in the trauma patient. The strong association between head injury, spinal cord injury and VTE confirms that we should pay special attention to VTE prophylaxis for our patients with these injuries.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore. Wong.th@doctors.org.uk.
authors.forename: T H
authors.initials: TH
authors.lastname: Wong
authors.affiliation: Department of General Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore.
authors.forename: M P
authors.initials: MP
authors.lastname: Koh
authors.affiliation: Department of General Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Ng
keywords: Asia; Deep vein thrombosis; Injury; Pulmonary embolism; Race; Trauma; Venous thromboembolism
references.citation: Ann Surg. 2004 Sep;240(3):490-6; discussion 496-8
references.pmid: 15319720
references.citation: J Trauma. 2007 Sep;63(3):620-4
references.pmid: 18073610
references.citation: Circulation. 2003 Jun 17;107(23 Suppl 1):I4-8
references.pmid: 12814979
references.citation: Asian J Surg. 2003 Jul;26(3):154-8
references.pmid: 12925290
references.citation: Injury. 2012 Sep;43(9):1502-6
references.pmid: 21722897
references.citation: Thromb Haemost. 2010 Nov;104(5):919-30
references.pmid: 20941466
references.citation: J Trauma. 2009 Dec;67(6):1244-9
references.pmid: 19779313
references.citation: Br J Surg. 2004 Apr;91(4):424-8
references.pmid: 15048741
references.citation: J Thromb Haemost. 2010 Jul;8(7):1515-23
references.pmid: 20345707
references.citation: Spinal Cord. 2008 Jul;46(7):523-6
references.pmid: 18227850
references.citation: Ann Surg. 2010 Feb;251(2):330-8
references.pmid: 20054273
references.citation: J Trauma. 2007 Mar;62(3):557-62; discussion 562-3
references.pmid: 17414328
references.citation: Arch Phys Med Rehabil. 2008 Dec;89(12 ):2316-23
references.pmid: 19061744
references.citation: Thromb Res. 2009;123 Suppl 4:S11-7
references.pmid: 19303496
references.citation: J Trauma. 2011 Feb;70(2):324-9
references.pmid: 21307729
references.citation: Ann Acad Med Singapore. 2002 Nov;31(6):761-4
references.pmid: 12520831
references.citation: Thromb Haemost. 2009 Jun;101(6):1095-9
references.pmid: 19492153
references.citation: Br J Haematol. 2009 Aug;146(4):369-83
references.pmid: 19552721
references.citation: J Trauma. 2002 Jul;53(1):142-64
references.pmid: 12131409
references.citation: J Thromb Haemost. 2011 Jan;9(1):85-91
references.pmid: 20942850
references.citation: J Thromb Haemost. 2005 Dec;3(12 ):2664-70
references.pmid: 16359505