Lethal Trauma Pulmonary Embolism is a Black Swan Event in Patients at Risk for Deep Vein Thrombosis: An Evidence-Based Review

2017 ◽  
Vol 83 (4) ◽  
pp. 403-413 ◽  
Author(s):  
C. Michael Dunham ◽  
Gregory S. Huang
Keyword(s):  
At Risk ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Confidence Interval ◽  
Hospital Stay ◽  
Trauma Patients ◽  
Black Swan ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Deep Vein

We delineated the incidence of trauma patient pulmonary embolism (PE) and risk conditions by performing a systematic literature review of those at risk for deep vein thrombosis (DVT). The PE proportion was 1.4 per cent (95% confidence interval = 1.2–1.6) in at-risk patients. Of 10 conditions, PE was only associated with increased age (P < 0.01) or leg injury (P < 0.01; risk ratio = 1.6). As lower extremity DVT (LEDVT) proportions increased, mortality proportions (P = 0.02) and hospital stay (P = 0.0002) increased, but PE proportions did not (P = 0.13). LEDVT was lower with chemoprophylaxis (CP) (4.9%) than without CP (19.1%; P < 0.01). PEwas lower withCP (1.0%) than without CP (2.2%; P = 0.0004). Mortality was lower with CP (6.6%) than without CP (11.6%; P = 0.002). PE was similar with (1.2%) and without (1.9%; P = 0.19) mechanical prophylaxis (MP). LEDVT was lower with MP (8.5%) than without MP (12.2%; P = 0.0005). PE proportions were similar with (1.3%) and without (1.5%; P = 0.24) LEDVTsurveillance. Mortality was higher with LEDVTsurveillance (7.9%) than without (4.8%; P < 0.01). A PE mortality of 19.7 per cent (95% confidence interval = 18–22) 3 a 1.4 per cent PE proportion yielded a 0.28 per cent lethal PE proportion. As PE proportions increased, mortality (P = 0.52) and hospital stay (P = 0.13) did not. Of 176 patients with PE, 76 per cent had no LEDVT. In trauma patients at risk for DVT, PE is infrequent, has a minimal impact on outcomes, and death is a black swan event. LEDVTsurveillance did not improve outcomes. Because PE was not associated with LEDVT and most patients with PE had no LEDVT, preventing, diagnosing, and treating LEDVT may be ineffective PE prophylaxis.

The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis

Surgery ◽  
2000 ◽  
Vol 128 (4) ◽  
pp. 631-640 ◽  
Author(s):  
Michelle M. Gearhart ◽  
Fred A. Luchette ◽  
Mary C. Proctor ◽  
Dave M. Lutomski ◽  
Christine Witsken ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Deep Vein Thrombosis ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Profile Score ◽  
Patients At Risk ◽  
Deep Vein

More than one in two venous thromboembolism treated in French hospitals occurs during the hospital stays

2015 ◽  
Vol 31 (6) ◽  
pp. 390-396 ◽  
Author(s):  
Francois-André Allaert ◽  
Eric Benzenine ◽  
Catherine Quantin
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Hospital Stay ◽  
Principal Diagnosis ◽  
Vein Thrombosis ◽  
Icd 10 ◽  
Hospital Stays ◽  
Deep Vein

Objective The objective was to describe the prevalence of venous thromboembolism, pulmonary embolism, and deep vein thrombosis among hospitalized patients and the percentages of those occurring during the hospital stays. Methods French DRG gave now the opportunity to investigate the frequency of venous thromboembolism occurring during the hospital stay. Statistics are issued from the national PMSI MCO databases encoded using the CIM10. Since 2010–2011 it is possible to differentiate the reason for hospital admission from the pathologies which secondly occurred. Any stay with the ICD-10 codes selected was considered as a hospital-occurred thrombosis unless it was the principal diagnosis of the first medical unit summary. To eliminate outpatient consultations or in day care, stays of <48 h were excluded. Results The results pertain to the 78,838,983 hospitalizations in France from 2005 to 2011 and on the 18,683,603 hospital stays in 2010–2011. The incidence of hospital stays came to 860,343 (1.09%) for venous thromboembolism, with 428,261 (0.543%) for deep vein thrombosis without pulmonary embolism and 432,082 (0.548%) for pulmonary embolism. It corresponds to an incidence of 189 per 100,000 inhabitants. Out of 100 hospital stays involving venous thromboembolism, for 40.3% venous thromboembolism was the cause of hospitalization whereas 59.7% can be considered to have occurred during hospital stay. These distributions are of 25.6 and 74.4% for deep vein thrombosis, respectively, 53.8 and 46.2% for pulmonary embolism. Conclusion The high proportion of hospital-occurred venous thromboembolism is an alarming situation that should question the quality of prevention and/or its effectiveness.

Deep Vein Thrombosis and Pulmonary Embolism: Awareness and Knowledge Gaps In the General Public and at-Risk Oncology Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4740-4740
Author(s):  
Frederick R Rickles ◽  
Gregory A Maynard ◽  
Richard J Friedman ◽  
Alan P Brownstein ◽  
Elizabeth A Varga ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
General Public ◽  
Risk Patient ◽  
Oncology Patients ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein

Abstract Abstract 4740 Deep vein thrombosis (DVT) and pulmonary embolism (PE) affect up to 600,000 individuals and account for ~100,000 deaths in the United States each year, according to The Surgeon General's Call to Action (CTA) To Prevent Deep Vein Thrombosis and Pulmonary Embolism (2008). Oncology patients, particularly those who are hospitalized or undergo chemotherapy, are at increased risk for DVT/PE. Mortality is greater among patients with cancer and venous thromboembolism (VTE) than among those with cancer alone. In response to the Surgeon General's CTA, the National Blood Clot Alliance (NBCA), a national, community-based, non-profit organization dedicated to the prevention, diagnosis, and treatment of thrombosis and thrombophilia, conducted a survey to benchmark DVT/PE awareness among the general public and several at-risk patient groups, including oncology patients. The literature contains little information about at-risk patient knowledge, and almost no information about general public knowledge of VTE, making this the first, large survey of both public and at-risk patient awareness of DVT/PE. The survey was conducted in November 2009, among a representative cross-section of 500 adults, >20 years, participating in online research panels. For comparison, the identical survey was conducted among a sample of 500 adults, >20 years, screened from an online research panel, who had received a cancer diagnosis or experienced recurrence of cancer within the past 6 months, or who were on active cancer treatment. Evaluations comparing survey responses provided by oncology patients who, in connection with their treatment, did require a hospital stay versus those who did not require a hospital stay showed no statistically significant differences in DVT/PE awareness between the two subgroups. Among all oncology patients surveyed, 24% said that they had heard of a medical condition called DVT, compared to 21% of the general public. Among all respondents who said that they knew what a DVT was (unaided) or who were able to correctly identify DVT on an aided checklist, 61% of oncology and 53% of national respondents said they could name DVT risk factors. The most frequently mentioned DVT risk factor was “sitting for a long time” among both the oncology (45%) and national (28%) samples. Among oncology patients who could name DVT risk factors (n=155), 8% named surgery, 1% named cancer treatment. Among national respondents who could name DVT risk factors (n=109), significantly more (79%) said they could name DVT signs/symptoms compared to oncology respondents (63%) who said the same. While not statistically significant, the national sample did show greater recognition of certain DVT signs/symptoms: skin redness/discoloration, 41% national, 21% oncology; leg swelling, 50% national, 31% oncology; and, leg pain, 37% national, 27% oncology. PE awareness was low among both groups, with 15% of all oncology and 16% of all national respondents saying that they had heard of PE. Of those who what said they knew what a PE was (unaided) or identified it correctly from an aided checklist, about one-third of both groups said they could name PE signs/symptoms, with “breathing difficulties” cited most frequently by oncology (69%) and national (73%) respondents. Significantly fewer oncology patients (28%) mentioned chest pain/tightness as a PE sign/symptom, compared to the national sample (57%). About 8 in 10 oncology and national respondents said that they did know what a blood clot is, and virtually all respondents (98%) recognized blood clots as life threatening. DVT/PE awareness/knowledge was low. Despite increased risk, oncology patients demonstrated no greater awareness of DVT/PE than the general public. DVT/PE education, utilizing interventions identified in the Surgeon General's DVT/PE CTA, should target the general public, with special emphasis on at-risk oncology patients to fill gaps relative to increased DVT/PE risks and signs/symptoms. Terms should be further simplified for future public awareness and patient education initiatives. Disclosures: Brownstein: Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.: Data reported from project supported by Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. Ansell:Bayer, Inc: Consultancy; Bristol Myers Squibb: Consultancy, Data Safety Monitoring Boards; Daiichi Sankyo: Consultancy; Boehringer Ingleheim: Consultancy; Ortho McNeil: Consultancy; Sanofi Aventis: Speakers Bureau.

scholarly journals EFFECTIVENESS OF RANGE OF MOTION (ROM) EXERCISES ON KNOWLEDGE AND PRACTICE OF CARE GIVERS OF PATIENTS AT RISK OF DEEP VEIN THROMBOSIS (DVT) ADMITTED IN A SELECTED TERTIARY HOSPITAL, DEHRADUN, UTTARAKHAND

2020 ◽  
pp. 79-80
Author(s):  
Neha Sharma ◽  
Harleen Kaur ◽  
Dipti. Y. Sorte ◽  
Sanchita Pugazhendi
Keyword(s):  
At Risk ◽  
Deep Vein Thrombosis ◽  
Range Of Motion ◽  
Pretest Score ◽  
Vein Thrombosis ◽  
Care Givers ◽  
Patients At Risk ◽  
Knowledge And Practice ◽  
Patient At Risk ◽  
Deep Vein

DVT is an ordinary issue after surgery, long bed rest. Mostly it occurs in a hospitalized patient who is immobile and suffering from long term illness. ROM is a term that determines the quantity of movement of each joint. The easiest intervention to maintain or enhance joint movement and also the blood flow in patients. Objective: To evaluate the effectiveness of range of motion exercises on knowledge and practice of care givers of patients at risk of Deep Vein Thrombosis. Methodology: A Time Series Research Design was used to evaluate the effectiveness of range of motion exercises on knowledge and practice of care givers of patients at risk of Deep Vein Thrombosis. Purposive sampling technique was used to select 94 care givers of patient at risk of Deep Vein Thrombosis. Data was collected by Interview method with the help of structured knowledge questionnaire and structured practice checklist. Results: Mean pretest score was computed 11.01±1.8 and mean posttest score was computed 23.94±0.37. So, the mean posttest knowledge score of caregivers of patient at risk of Deep Vein Thrombosis and Range of motion exercises was higher than that of their mean pretest knowledge scores. Repeated Measure ANOVA was performed to find the difference in the practice score between three observations. Mean posttest practice score was higher than that of their mean pretest score. Mean pretest practice score was 7.59±1.10 and mean posttest practice scores were 9.67+0.51, 10±0. Conclusion: Present research Study concluded that intervention on range of motion exercises was effective to improve the knowledge and practices of care givers of patient at risk of Deep Vein Thrombosis.

scholarly journals Real-World Rates of In-hospital and Postdischarge Deep-Vein Thrombosis and Pulmonary Embolism in At-Risk Medical Patients in the United States

2011 ◽  
Vol 17 (6) ◽  
pp. 611-619 ◽  
Author(s):  
Alpesh N. Amin ◽  
Jay Lin ◽  
Stephen Thompson ◽  
Daniel Wiederkehr
Keyword(s):  
Infectious Disease ◽  
At Risk ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
The United States ◽  
Outpatient Setting ◽  
Medical Patients ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Deep Vein

Hospitalized medical patients are at risk of deep-vein thrombosis (DVT) and pulmonary embolism (PE). We evaluated inpatient and postdischarge DVT/PE and thromboprophylaxis rates in US medical patients, using patient admissions from January 2005 to November 2007 in the Premier Perspective™-i3 Pharma Informatics database. Among 15 721 patients with cancer, congestive heart failure, severe lung disease, and infectious disease, 39.0% received inpatient thromboprophylaxis, with the highest rate in patients with cancer (51.9%). In all, 3.4% received outpatient pharmacological prophylaxis. Mean ± SD prophylaxis duration was 2.2 ± 5.7 days. Overall, 3.0% of inpatients had symptomatic DVT/PE, and an additional 1.1% of patients were rehospitalized for DVT/PE or treated in the outpatient setting. Patients with infectious disease had the highest rate of DVT/PE (4.6%). Inpatient DVT/PE and prophylaxis rates of the different medical conditions had a negative correlation ( R 2 = 0.72). This analysis demonstrates the burden of DVT/PE and highlights the underuse of thromboprophylaxis across the continuum of care.

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