Association Between Inferior Vena Cava Filter Insertion in Trauma Patients and In-Hospital and Overall Mortality.
Trauma patients admitted to the hospital are at increased risk of bleeding and thrombosis. The use of inferior vena cava (IVC) filters in this population has been increasing, despite a lack of high-quality evidence to demonstrate their efficacy.



To determine if IVC filter insertion in trauma patients affects overall mortality.



This retrospective cohort study used stratified 3:1 propensity matching to select a control population similar to patients who underwent IVC filter insertion at Boston Medical Center (a level I trauma center at Boston University School of Medicine) between August 1, 2003, and December 31, 2012. Among patients with an IVC filter and matched controls, age, sex, race/ethnicity, and Injury Severity Score were entered into a multivariable logistic regression model to calculate a propensity score. Matching was stratified by the date of injury.



Multivariable logistic regression was used to compare hospital mortality across both groups, adjusting for age, sex, race/ethnicity, Injury Severity Score, and brain injury severity using the head and neck Abbreviated Injury Score. To determine any significant difference in mortality, patient characteristics and mortality data from the National Death Index were analyzed in all patients and in those who survived 24, 48, and 72 hours after injury, as well as at hospital discharge.



Among 451 trauma patients with an IVC filter and 1343 matched controls without an IVC filter, the mean (SD) age was 47.4 (21.5) years. The median Injury Severity Score overall was 24 (range, 1-75). Based on a mean follow-up of 3.8 years (range, 0-9.4 years), there was no significant difference in overall mortality or cause of mortality in patients with vs without an IVC filter who survived more than 24 hours from the time of injury, independent of the presence or absence of deep vein thrombosis or pulmonary embolism at the time of IVC filter placement. Additional analyses at shorter intervals of 6 months and 1 year after discharge also showed no significant difference between the 2 groups of patients. Eight percent (38 of 451) of the IVC filters were removed at Boston Medical Center during the follow-up period.



The research herein demonstrates no significant difference in survival in trauma patients with vs without placement of an IVC filter, whether in the presence or absence of venous thrombosis. The use of IVC filters in this population should be reexamined because filter removal rates are low and there is increased risk of morbidity in patients with filters that remain in place.
Department of Hematology, Boston University School of Medicine, Boston, Massachusetts.
Shayna
S
Sarosiek
Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts.
Denis
D
Rybin
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Janice
J
Weinberg
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Peter A
PA
Burke
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
George
G
Kasotakis
Department of Hematology, Boston University School of Medicine, Boston, Massachusetts.
J Mark
JM
Sloan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D011655:Pulmonary Embolism / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000150:complications; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult