BackgroundDeep Vein Thrombosis (DVT) is a common complication in trauma patients. Venous duplex surveillance is used widely for the diagnosis of DVT, however, there is controversy concerning its appropriate use. The Wells criterion is a clinically validated scoring system in an outpatient setting, but its use in trauma patients has not been studied. This study evaluated the application of the Wells scoring system in trauma population.MethodsWells scores were calculated retrospectively for all patients who were admitted to the trauma service and underwent Venous Duplex Scanning (VDS) at the author’s institution between 2012 and 2013. Correlation of Wells score with DVT and its efficacy in risk stratifying the patients after trauma was analyzed using linear correlation and receiver operating characteristic (ROC) curve. Sensitivity and specificity of Wells score in ruling out or ruling in DVT were calculated in various risk groups.ResultsOf 298 patients evaluated, 18 (6 %) patients were positive for DVT. A linear correlation was present between Wells score and DVT with R2 = 0.88 (p = 0.0016). Median Wells score of patients without DVT was 1 (1–3) compared to a median score of 2 (1–5) in those with DVT (p < 0.0001). In low risk patients (scores <1), Wells scoring was able to rule out the possibility of DVT with a sensitivity of 100 % and NPV of 100 %, while in moderate-high risk patients (scores ≥2), it was able to predict DVT with a specificity of 90 %. Area under ROC curve was 0.859 (p < 0.0001) demonstrating the accuracy of Wells scoring system for DVT risk stratification in post trauma patients.ConclusionsA Wells score of <1 can reliably rule out the possibility of DVT in the trauma patients. Risk of developing DVT correlates linearly with Wells score, establishing it as a valid pretest tool for risk stratification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0078-1) contains supplementary material, which is available to authorized users.

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Severe hypothermia and frostbite can result in significant morbidity and mortality. We present a case of a patient with severe hypothermia and frostbite due to cold exposure after a snowmobile crash. He presented in cardiac arrest with a core temperature of 19 degrees Celsius requiring prolonged cardiopulmonary resuscitation, active internal rewarming, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and subsequently amputations of all four extremities. Although severe hypothermia and frostbite can be a fatal condition, the quick action of EMS, emergency physicians, trauma surgeons, cardiothoracic surgeons, intensivists and the burn team contributed to a successful recovery for this patient including a good neurologic outcome. This case highlights the importance of a strong interdisciplinary team in treating this condition.

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Learning Objectives: Enoxaparin (EN) is widely used for prophylaxis (ppx) and treatment (tx) of venous thromboembolism (VTE); yet appropriate dosing has not been established in trauma patients. The monitoring of anti-Xa levels may be helpful in determining whether dosing is achieving concentrations within target ranges. The purpose of this study was to assess adherence to the EN initial dosing and subsequent adjustments based on anti-Xa level recommendations per a pilot protocol. Methods: The pilot protocol was implemented in 2011. The initial dosing recommended for VTE ppx is 30mg every 12 hours for patients with BMI ≤30 and 40mg every 12 hours for BMI ≥31. Treatment dosing was initiated at 1mg/kg twice a day. Dosing of EN was subsequently adjusted by titrating up or