Trauma patients at risk for venous thromboembolism who undergo routine duplex ultrasound screening experience fewer pulmonary emboli: A prospective randomized trial

Kay, Annika Bickford; Morris, David S.; Woller, Scott C.; Stevens, Scott M.; Bledsoe, Joseph; Lloyd, James F.; Collingridge, David; Majercik, Sarah

doi:10.1097/ta.0000000000003104

Cited by 18 publications

(27 citation statements)

References 48 publications

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“…APE is a common clinical emergency with a complex etiology. Previous studies believed that the occurrence of APE was related to factors such as long-term bed rest and chronic lung disease [ 14 ]. APE was easy to cause AF, which posed a threat to patients' life safety, so the hidden danger of APE complicated with AF cannot be ignored [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

An Auxiliary Scoring Model for Patients with Acute Pulmonary Embolism Complicated with Atrial Fibrillation Was Established Based on Random Forests

Zhang

Guan

Qin

et al. 2022

Emergency Medicine International

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The purpose of this study was to explore the establishment of an auxiliary scoring model for patients with acute pulmonary embolism (APE) complicated with atrial fibrillation (AF) based on random forest (RF) and its application effect. A retrospective analysis was performed on the general data, underlying diseases, laboratory indicators, and cardiac indicators of 100 patients with APE admitted to our hospital from 2018 to 2021. The occurrence of atrial fibrillation in patients with pulmonary embolism was taken as a categorical variable, and the general data, underlying diseases, laboratory indicators, and cardiac indicators were taken as input variables. Then, the risk auxiliary scoring model for patients with APE complicated with AF was established based on RF and logistic regression. Finally, the accuracy, sensitivity, specificity, recall rate, accuracy, F1 value, and the receiver operator characteristic (ROC) curve were used to evaluate the predictive value of the models. After statistical analysis, the optimal node value was 3 and the optimal number of decision trees was 500 in the RF model. The importance of predictors in descending order were Hcy, diabetes mellitus, FT3 level, UA level, left atrial diameter, hypertension, and smoking history. The prediction accuracy of the RF model was 0.934, sensitivity 0.966, specificity 0.876, recall rate 0.9660, accuracy 0.934, and F1 value 0.950. The logistic regression model prediction accuracy was 0.816, sensitivity 0.915, specificity 0.125, recall rate 0.902, accuracy 0.811, and F1 value 0.896. The RF model and logistic regression prediction model AUC values were 0.984 and 0.883, respectively. From this, we conclude that the RF model was better than the logistic regression model in predicting AF in APE patients. So, the RF model had the clinical application value.

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Section: Discussionmentioning

confidence: 99%

An Auxiliary Scoring Model for Patients with Acute Pulmonary Embolism Complicated with Atrial Fibrillation Was Established Based on Random Forests

Zhang

Guan

Qin

et al. 2022

Emergency Medicine International

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“…thromboembolism reported a significant reduction in pulmonary embolism incidence using screening duplex ultrasound of the lower extremities. 29 The disadvantage is that anticoagulation may be initiated for a thrombus that may not become symptomatic, which increases the risk of bleeding in a patient that did not need to be anticoagulated. 30 Recent guidelines from the American Association of Surgery for Trauma (AAST) recommend screening for thromboembolism in high-risk patients, although high risk is not defined.…”

Section: Resultsmentioning

confidence: 99%

“…The theoretical value of active screening is that it allows for earlier detection of thrombosis and the initiation of anticoagulation if appropriate 28 . For example, an RCT of approximately 2000 trauma patients at moderate to high risk of thromboembolism reported a significant reduction in pulmonary embolism incidence using screening duplex ultrasound of the lower extremities 29 . The disadvantage is that anticoagulation may be initiated for a thrombus that may not become symptomatic, which increases the risk of bleeding in a patient that did not need to be anticoagulated 30 .…”

Section: Discussionmentioning

confidence: 99%

The risk of thromboembolic events with early intravenous 2‐ and 4‐g bolus dosing of tranexamic acid compared to placebo in patients with severe traumatic bleeding: A secondary analysis of a randomized, double‐blind, placebo‐controlled, single‐center trial

et al. 2022

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Background Screening for the risk of thromboembolism (TE) due to tranexamic acid (TXA) in patients with severe traumatic injury has not been performed in randomized clinical trials. Our objective was to determine if TXA dose was independently‐associated with thromboembolism. Study Design and Methods This is a secondary analysis of a single‐center, double‐blinded, randomized controlled trial comparing placebo to a 2‐g or 4‐g intravenous TXA bolus dose in trauma patients with severe injury. We used multivariable discrete‐time Cox regression models to identify associations with risk for thromboembolic events within 30 days post‐enrollment. Event curves were created using discrete‐time Cox regression. Results There were 50 patients in the placebo group, 49 in the 2‐g, and 50 in the 4‐g TXA group. In adjusted analyses for thromboembolism, a 2‐g dose of TXA had an hazard ratio (HR, 95% confidence interval [CI]) of 3.20 (1.12–9.11) (p = .029), and a 4‐g dose of TXA had an HR (95% CI) of 5.33 (1.94–14.63) (p = .001). Event curves demonstrated a higher probability of thromboembolism for both doses of TXA compared to placebo. Other parameters independently associated with thromboembolism include time from injury to TXA administration, body mass index, and total blood products transfused. Discussion In patients with severe traumatic injury, there was a dose‐dependent increase in the risk of at least one thromboembolic event with TXA. TXA should not be withheld, but thromboembolism screening should be considered for patients receiving a dose of at least 2‐g TXA intravenously for traumatic hemorrhage.

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“…However, routine duplex screening in patients with high-risk injury patterns may be justified 37 and cost-effective 38 . A prospective randomized trial published in 2021 found that screening in patients with high risk-assessment scores was associated with fewer PE 39 . The added benefit of this approach over and above a rigorous protocol for timely pharmacologic prophylaxis remains uncertain.…”

Section: A Brief History Of Vte Research In Injured Patientsmentioning

confidence: 99%

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Haut¹,

Byrne²,

Price³

et al. 2022

J Trauma Acute Care Surg

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On May 4 and 5, 2022, a meeting of multidisciplinary stakeholders in the prevention and treatment of venous thromboembolism (VTE) after trauma was convened by the Coalition for National Trauma Research, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and hosted by the American College of Surgeons in Chicago, Illinois. This consensus conference gathered more than 40 in-person and 80 virtual attendees, including trauma surgeons, other physicians, thrombosis experts, nurses, pharmacists, researchers, and patient advocates. The objectives of the meeting were twofold: (1) to review and summarize the present state of the scientific evidence regarding VTE prevention strategies in injured patients and (2) to develop consensus on future priorities in VTE prevention implementation and research gaps. To achieve these objectives, the first part of the conference consisted of talks from physician leaders, researchers, clinical champions, and patient advocates to summarize the current state of knowledge of VTE pathogenesis and prevention in patients with major injury. Video recordings of all talks and accompanying slides are freely available on the conference website (https://www.nattrauma.org/research/research-policies-templatesguidelines/vte-conference/). Following this curriculum, the second part of the conference consisted of a series of small-group breakout sessions on topics potentially requiring future study. Through this process, research priorities were identified, and plans of action to develop and undertake future studies were defined. The 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma answered the National Trauma Research Action Plan call to define a course for future research into preventing thromboembolism after trauma. A multidisciplinary group of clinical champions, physicians, scientists, and patients delineated clear objectives for future investigation to address important, persistent key knowledge gaps. The series of papers from the conference outlines the consensus based on the current literature and a roadmap for research to answer these unanswered questions.

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Trauma patients at risk for venous thromboembolism who undergo routine duplex ultrasound screening experience fewer pulmonary emboli: A prospective randomized trial

Cited by 18 publications

References 48 publications

An Auxiliary Scoring Model for Patients with Acute Pulmonary Embolism Complicated with Atrial Fibrillation Was Established Based on Random Forests

An Auxiliary Scoring Model for Patients with Acute Pulmonary Embolism Complicated with Atrial Fibrillation Was Established Based on Random Forests

The risk of thromboembolic events with early intravenous 2‐ and 4‐g bolus dosing of tranexamic acid compared to placebo in patients with severe traumatic bleeding: A secondary analysis of a randomized, double‐blind, placebo‐controlled, single‐center trial

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

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