Hidden burden of venous thromboembolism after trauma: A national analysis

Rattan, Rishi; Parreco, Joshua; Eidelson, Sarah A.; Gold, Joann; Dharmaraja, Arjuna; Zakrison, Tanya L.; Yeh, D. Dante; Ginzburg, Enrique; Namias, Nicholas

doi:10.1097/ta.0000000000002039

Cited by 27 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, risk factors for readmission to different hospitals are unique and include the index treatment at small and/or for‐profit hospitals. Similar findings have been noted in other works studying different‐hospital readmissions 3–6 …”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Cioci

Kedar²,

Urréchaga

et al. 2021

BJOG

View full text Add to dashboard Cite

Objective To quantify the proportion of postpartum venous thromboembolism (VTE) readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome. Design Retrospective observational study. Setting US hospitals included in the Nationwide Readmissions Database. Sample A total of 3 719 238 patients >14 years of age with a delivery‐associated hospitalisation in 2014. Methods Univariate analysis was performed to identify patient and hospital factors associated with readmissions. Significant factors were included in multivariate logistic regression to identify independent risk factors. Results were weighted for national estimates. Main outcome measures Readmission with VTE to both index and different hospitals at 30, 60 and 90 days. Results The VTE cumulative readmission rate was 0.053% (n = 1477), 0.063% (n = 1765) and 0.069% (n = 1938) at 30, 60 and 90 days, respectively. Patients were readmitted to different hospitals 31% of the time within 90 days. Risk factors for different hospital VTE readmission were unique and included younger age and initial admission to a small/medium‐sized hospital. Initial admission to a for‐profit hospital increased the likelihood of readmission to a different hospital. Conclusions Nearly one in three postpartum VTEs are missed by the current quality metrics, with significant implications for outcomes and quality. For‐profit hospitals have a significant portion of their VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. Tweetable abstract US analysis shows 1 in 3 readmissions for postpartum venous thromboembolism currently missed.

show abstract

Section: Discussionsupporting

confidence: 92%

“…Benchmarks are based on readmission to the same hospital, and are assumed to be both accurate and similar between different hospital types 2 . However, same‐hospital readmission rates have been demonstrated to be inaccurate and different‐hospital readmission rates vary by hospital type 3–6 …”

Section: Introductionmentioning

confidence: 99%

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Cioci

Kedar²,

Urréchaga

et al. 2021

BJOG

View full text Add to dashboard Cite

show abstract

“…Furthermore, trauma patients exhibit increased thrombin generation in comparison with healthy controls [26,[30][31][32]. Importantly, patients hospitalized after trauma encounter a substantially elevated risk of venous thromboembolism, and elevated thrombin generation has been shown to be an independent predictor for venous thromboembolic events in this patient cohort [33,34].…”

Section: Discussionmentioning

confidence: 87%

Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study

Gratz

Schlimp

Honickel

et al. 2020

JCM

View full text Add to dashboard Cite

Guidelines for the treatment of severe bleeding comprise viscoelastic-test-guided use of coagulation factor concentrates as part of their recommendations. The aim of this study is to investigate the effects of substituting fibrinogen, prothrombin complex concentrate, and a combination of both on conventional coagulation tests, viscoelastic test results, and thrombin generation. Blood was drawn from seven healthy volunteers to obtain platelet-free plasma, which later was diluted by replacing 40%, 60%, 80%, 90%, 95%, and 99% with a crystalloid solution. The diluted samples were spiked with fibrinogen concentrate, prothrombin complex concentrate, a combination of both, or a corresponding amount of crystalloid solution. Up to a dilution level of 95%, viscoelastically determined clotting time was significantly shorter in the group substituted with fibrinogen only in comparison with the additional use of prothrombin complex concentrate. Clot firmness and endogenous thrombin potential remained at relatively stable values up to a dilution level of 95% with the substitution of fibrinogen but not prothrombin complex concentrate. Substitution of prothrombin complex concentrate led to an excessive overshoot of thrombin generation. The results of our study question currently propagated treatment algorithms for bleeding patients that include the use of prothrombin complex concentrate for patients without former intake of oral anticoagulants. Even in severely bleeding patients, thrombin generation might be sufficient to achieve adequate hemostasis.

show abstract

“… 95 , 97 Venous thromboembolism–related readmissions account for 1.2% of 1-year trauma readmissions at a cost of US $250 million annually. 99 …”

Section: Algorithmmentioning

confidence: 99%