Venous Thromboembolism Among Military Combat Casualties

Fang, Raymond; Rodríguez, Carlos J.

doi:10.1007/s40719-016-0037-z

Cited by 4 publications

(5 citation statements)

References 21 publications

(22 reference statements)

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“…However, our rate is similar to the incidence others have published for combat casualty studies where VTE was a central focus . The trauma patient is known to be at increased risk for VTE, and the combat trauma patient population subset is at even higher risk . In addition, our cohort was severely injured and required medical evacuation to the US, with prolonged periods of immobility .…”

Section: Discussionsupporting

confidence: 83%

“…The trauma patient is known to be at increased risk for VTE, and the combat trauma patient population subset is at even higher risk . In addition, our cohort was severely injured and required medical evacuation to the US, with prolonged periods of immobility . These factors place our patients at great risk for VTE and may explain our higher event rates.…”

Section: Discussionmentioning

confidence: 93%

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Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events

et al. 2018

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 93%

Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events

et al. 2018

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“…In addition, VTE can lead to prolonged hospital stay and incur substantial economic burden, with an estimated cost to the US healthcare system of at least $7–12 billion each year 4. In the military healthcare system, VTE presents additional challenges with its high incidence and added risk factors such as above-knee amputations and prolonged immobilisation from intercontinental aeromedical transport due 5 6. Although VTE prophylaxis exists, identifying high-risk patients can be challenging as patients may be asymptomatic, may have a contraindication to chemical prophylaxis due to risk of haemorrhage, or may be in multiorgan failure and too sick to undergo imaging studies such as contrast-enhanced CT 7.…”

Section: Introductionmentioning

confidence: 99%

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

et al. 2020

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IntroductionVenous thromboembolism (VTE) is a frequent complication of trauma associated with high mortality and morbidity. Clinicians lack appropriate tools for stratifying trauma patients for VTE, thus have yet to be able to predict when to intervene. We aimed to compare random forest (RF) and logistic regression (LR) predictive modelling for VTE using (1) clinical measures alone, (2) serum biomarkers alone and (3) clinical measures plus serum biomarkers.MethodsData were collected from 73 military casualties with at least one extremity wound and prospectively enrolled in an observational study between 2007 and 2012. Clinical and serum cytokine data were collected. Modelling was performed with RF and LR based on the presence or absence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). For comparison, LR was also performed on the final variables from the RF model. Sensitivity/specificity and area under the curve (AUC) were reported.ResultsOf the 73 patients (median Injury Severity Score=16), nine (12.3%) developed VTE, four (5.5%) with DVT, four (5.5%) with PE, and one (1.4%) with both DVT and PE. In all sets of predictive models, RF outperformed LR. The best RF model generated with clinical and serum biomarkers included five variables (interleukin-15, monokine induced by gamma, vascular endothelial growth factor, total blood products at resuscitation and presence of soft tissue injury) and had an AUC of 0.946, sensitivity of 0.992 and specificity of 0.838.ConclusionsVTE may be predicted by clinical and molecular biomarkers in trauma patients. This will allow the development of clinical decision support tools which can help inform the management of high-risk patients for VTE.

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“…The incidence of VTE has varied in civilian trauma literature with recent studies reporting rates as low as 0.36% to as high as 9.1% 2–4. However, the VTE incidence in military combat casualties has been shown to be even higher, ranging from 2.2% to 28% 5–10. This disparity in VTE rates is likely related to the differences between military and civilian trauma patients.…”

Section: Introductionmentioning

confidence: 99%

“…This disparity in VTE rates is likely related to the differences between military and civilian trauma patients. Combat casualties frequently have additional risk factors for VTE not often encountered in civilian trauma patients including multiple and/or above-knee amputations as well as prolonged immobilization at altitude during long distance aeromedical evacuation 5. Consistent with the Eastern Association for the Surgery of Trauma and CHEST guidelines,11 12 the current Department of Defense Joint Trauma System (JTS) Clinical Practice Guidelines regarding VTE prevention recommend initiation of chemoprophylaxis in trauma patients once ongoing bleeding and coagulopathy have been corrected 13.…”

Section: Introductionmentioning

confidence: 99%

Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism

Walker

Schobel

Caruso

et al. 2019

Trauma Surg Acute Care Open

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IntroductionClinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.MethodsA retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.ResultsThe incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4–9), and the median TESS for those with VTE was 10 (IQR 9–11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).ConclusionsWhen used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.Level of evidenceLevel III.

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Venous Thromboembolism Among Military Combat Casualties

Cited by 4 publications

References 21 publications

Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events

Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism

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