title: An analysis of deep vein thrombosis in burn patients (Part 1): Comparison of D-dimer and Doppler ultrasound as screening tools.
abstract: BACKGROUND
  The high prevalence of deep vein thrombosis (DVT) reported in prospective studies and the unreliability of clinical diagnosis mandates prospective screening for DVT in burn patients. Our study seeks to compare D-dimer and Doppler ultrasound (DUS) in search for a practical, inexpensive and a reliable screening tool.
  
  
  METHODS
  One hundred burn patients (inclusion criteria: 30-60% TBSA burn, >18 years of age, admitted within 48h of burn) were computer randomized into two equal groups. The study (prophylaxis) group received low molecular weight heparin (LMWH) (0.5mg/kg, twice daily-max 60mg/day) from day one, till discharge. Screening D-dimer assays and DUS of the lower extremities were performed on all 100 patients on day five, and then weekly, till discharge.
  
  
  RESULTS
  Signs and symptoms simulating DVT (pain, swelling, redness, warmth, positive Homans' and Moses' sign) were present in majority of patients with lower limb burns. 43/50 patients (86%) in the control group and 38/50 patients (76%) in the study (prophylaxis) group had positive D-dimer values (>0.5μg/ml) on the 5th post-burn day. D-dimer was positive in all the four patients identified with DVT. However, only 4/100 patients enrolled in the study demonstrated DVT on DUS. Thus, the specificity of the D-dimer assay was only 20% with a positive predictive value of 5%. Absolute D-dimer values were found to have no correlation to the extent of burns.
  
  
  CONCLUSIONS
  We conclude that D-dimer is not a useful screening tool for DVT in burns contrary to its accepted value in general trauma and medical patients.
authors.affiliation: Department of Burns and Plastic Surgery, New Delhi 110 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India. Electronic address: rbahuja@gmail.com.
authors.forename: Rajeev B
authors.initials: RB
authors.lastname: Ahuja
authors.affiliation: Department of Burns and Plastic Surgery, New Delhi 110 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Bansal
authors.affiliation: Department of Radiology, Lok Nayak Hospital, New Delhi 110 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India.
authors.forename: Gaurav S
authors.initials: GS
authors.lastname: Pradhan
authors.affiliation: Associated Maulana Azad Medical College, New Delhi 110 002, India; Department of Biochemistry, G.B. Pant Hospital, New Delhi 110 002, India.
authors.forename: Manju
authors.initials: M
authors.lastname: Subberwal
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D019468:Disease Management; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000517:prevention & control; D055815:Young Adult
chemical_list: D017984:Enoxaparin; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D
keywords: D-dimer; DVT in burns; DVT screening; Deep vein thrombosis