587 DVT Screening in Lower Extremity Burns
Abstract Introduction Burn patients are at in increased risk for developing deep vein thromboses (DVT), with rates as high as 6%. Known risk factors include large burn size, use of central lines, increasing age, male, active smoker or alcoholic, increased blood transfusions and surgeries. No study to date has looked specifically at burn location as a possible risk factor. We hypothesized that lower extremity burns with delayed presentation to our burn center are at in increased risk for DVT formation. Methods A DVT screening protocol was developed and implemented for all burn patients admitted to our burn unit starting in May 2017. Patients who presented with lower extremity burns >48 hours from their injury time underwent screening ultrasounds at admission to evaluate for DVT in the affected extremity. Data was collected from May 2017 through December 2018 for all lower extremity patients. Screened patients were identified by reviewing the burn registry for patients admitted >2 days from their injury date and then reviewing the electronic medical record for screening US. DVT rates were compared between screened patients and the overall rate for all admissions during the study period. Results There were 1041 patients admitted to the burn unit during the study period, including 445 lower extremity burns with 118 admitted >48 hours after their burn injury. The overall compliance rate with the screening protocol was 41.5% (49/118). There were a total of 4 DVT’s diagnosed among all admitted patients during the study period (1 lower extremity, 3 upper extremity), giving an overall rate of 0.5% for our unit. No DVT’s were identified in the delayed presentation group (p=0.46). Conclusions Our overall DVT rate was much lower than quoted rates in the literature. Patients with lower extremity burns and delayed presentation to a burn center do not appear to be at increased risk for DVT. Compliance with our screening protocol was relatively poor, which may be due to short hospital stays and unavailability of ultrasound on weekends for non-urgent studies. Applicability of Research to Practice Patients with lower extremity burns should receive routine DVT prophylaxis (chemical and mechanical) similar to other burn patients.