Duplex ultrasound screening detects high rates of deep vein thromboses in critically ill trauma patients

Abstract

Lower extremity DVT is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, DVT risk factors, or pharmacologic prophylaxis. Previous studies have underestimated DVT rates by not investigating CVDVTs and not exclusively targeting critically ill patients. We recommend early and continued DUS DVT screening of all critically ill trauma patients.

Venous thromboembolism after trauma

“…Nonetheless, many reports support the value of routine VDU screening (6,9,(16)(17)(18)(19)(20)(21)(22)(23). Initial VDU is typically performed in the first 48 hrs of admission, but timing of repeat examinations may be weekly (6,9,16,17,20), biweekly (19,21), or vary during the course of hospitalization (22). Likewise, the length of follow-up is highly variable; VDU may only be performed while in the intensive care unit (17), for the first 30-day postinjury (6), or until hospital discharge (9,19,22).…”

“…Initial VDU is typically performed in the first 48 hrs of admission, but timing of repeat examinations may be weekly (6,9,16,17,20), biweekly (19,21), or vary during the course of hospitalization (22). Likewise, the length of follow-up is highly variable; VDU may only be performed while in the intensive care unit (17), for the first 30-day postinjury (6), or until hospital discharge (9,19,22). The rates of VTE vary widely in these studies, from 3.2% in Adams et al (16) to 21% in Burns et al (19).…”

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…In major trauma patients, screening for asymptomatic DVT has definitely been shown to detect more thrombi (Winemiller, 1999;Furlan, 2007;Pierce, 2008;Haut, 2009;Azarbal, 2011;Jawa, 2011;Dietch, 2015). Similarly, among acute SCI patients managed at the Mayo Clinic from 1976 to 1995, the use of DVT screening was the strongest predictor of a VTE diagnosis, with a risk ratio of 2.8-fold compared with patients not screened (Winemiller, 1999).…”

“…The rationale for screening SCI patients to find clinically inapparent DVT is based on the premise that detection of silent DVT would identify patients who would then be given therapeutic anticoagulation, which might reduce symptomatic and fatal PE (Azarbal, 2011;Haut, 2011;Bandle, 2013). Regular physical examination of the legs is not an effective means to reduce clinically important thromboembolic complications because this strategy has both low sensitivity and low specificity for the detection of DVT, especially in SCI patients who frequently have sensory loss and almost always have leg swelling (Swarczinski, 1991;Geerts, 1994;Schwarcz, 2001).…”

“…Of key importance is the fact that the clinical significance (and the need for treatment) of asymptomatic abnormalities detected by routine DUS screening is uncertain (Azarbal, 2011;Bandle, 2013).…”