title: Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance.
abstract: BACKGROUND
  Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs) than lower extremity DVTs (LEDVTs), and therefore, all extremities should be evaluated.
  
  
  METHODS
  A retrospective chart and trauma registry review of Intensive Care Unit trauma patients with upper and LEDVTs detected on surveillance duplex ultrasound from January 2010 to December 2014 was carried out. Variables reviewed were age, gender, injury severity score, injury mechanism, clot location, day of clot detection, presence of central venous pressure catheter, presence of inferior vena cava filter, mechanical ventilation, and fracture.
  
  
  RESULTS
  A total of 136 patients had a DVT in a 5-year period: upper - 71 (52.2%), lower - 61 (44.9%), both upper and lower - 4 (2.9%). Overall, 75 (55.2%) patients had a UEDVT. Upper DVT vein: Brachial (62), axillary (26), subclavian (11), and internal jugular (10). Lower DVT vein: femoral (58), popliteal (14), below knee (4), and iliac (2). 10.3% had a PE: UEDVT - 5 (6.7%) and LEDVT - 9 (14.8%)P= 0.159.
  
  
  CONCLUSIONS
  The majority of the DVTs in the study were in the upper extremities. For trauma centers that aggressively screen the lower extremities with venous duplex ultrasound, surveillance to include the upper extremities is warranted.
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Alonso
authors.initials: A
authors.lastname: Andrade
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Tyroch
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: McLean
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Smith
authors.affiliation: Trauma Center, University Medical Center of El Paso, El Paso, Texas, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Ramos
keywords: Anticoagulation; deep venous thrombosis; ultrasound duplex surveillance; upper extremity deep venous thrombosis; venous thromboembolism prophylaxis