A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

Abstract Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

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Surveillance and Early Management of Deep Vein Thrombosis Decreases the Rate of Pulmonary Embolism in High-Risk Trauma Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.07.400 ◽

2015 ◽

Vol 221 (4) ◽

pp. S167

Author(s):

Casey J. Allen ◽

Jonathan P. Meizoso ◽

Joyce Kaufman ◽

Laura F. Teisch ◽

Xiomara D. Ruiz ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

High Risk ◽

Trauma Patients ◽

Early Management ◽

Vein Thrombosis ◽

Deep Vein

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Deep Vein Thrombosis Prophylaxis in Trauma Patients

Thrombosis ◽

10.1155/2011/505373 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 47

Author(s):

Serdar Toker ◽

David J. Hak ◽

Steven J. Morgan

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

High Risk ◽

Vena Cava ◽

Trauma Patients ◽

Mechanical Prophylaxis ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Deep Vein

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are known collectively as venous thromboembolism (VTE). Venous thromboembolic events are common and potentially life-threatening complications following trauma with an incidence of 5 to 63%. DVT prophylaxis is essential in the management of trauma patients. Currently, the optimal VTE prophylaxis strategy for trauma patients is unknown. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been considered risk factors for VTE; however it is unclear which combination of risk factors defines a high-risk group. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical prophylaxis, and inferior vena cava (IVC) filters. The available pharmacologic agents include low-dose heparin (LDH), low molecular weight heparin (LMWH), and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings (GCSs), pneumatic compression devices (PCDs), and A-V foot pumps. IVCs are traditionally used in high risk patients in whom pharmacological prophylaxis is contraindicated. Both EAST and ACCP guidelines recommend primary use of LMWHs in trauma patients; however there are still controversies regarding the definitive VTE prophylaxis in trauma patients. Large randomized prospective clinical studies would be required to provide level I evidence to define the optimal VTE prophylaxis in trauma patients.

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Surveillance and Early Management of Deep Vein Thrombosis Decreases Rate of Pulmonary Embolism in High-Risk Trauma Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.10.014 ◽

2016 ◽

Vol 222 (1) ◽

pp. 65-72 ◽

Cited By ~ 16

Author(s):

Casey J. Allen ◽

Clark R. Murray ◽

Jonathan P. Meizoso ◽

Enrique Ginzburg ◽

Carl I. Schulman ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

High Risk ◽

Trauma Patients ◽

Early Management ◽

Vein Thrombosis ◽

Deep Vein

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Development and Prospective Validation of a Novel Risk Score for Predicting the Risk of Lower Extremity Deep Vein Thrombosis Among Trauma Patients

10.21203/rs.3.rs-60081/v1 ◽

2020 ◽

Author(s):

Guoxuan Peng ◽

Qiang Wang ◽

Hong Sun ◽

Lebin Gan ◽

Hongxiang Lu ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Lower Extremity ◽

Risk Score ◽

Early Identification ◽

Study Cohort ◽

Trauma Patients ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein

Abstract Background: Trauma patients have an increased risk of deep vein thrombosis (DVT). Early identification of patients with a high risk of DVT after trauma is crucial for thromboembolism prophylaxis. We aimed to develop and prospectively validate a novel risk score based on a nomogram to predict lower extremity DVT among trauma patients.Methods: Clinical data were collected from 281 trauma patients who were admitted to our trauma center within 24 h of admission from September 2016 to January 2019 to develop a novel DVT risk score. The DVT risk estimates were then calculated prospectively based on the score in a new study cohort from February 2019 to July 2020. The technique of least absolute shrinkage and selection operator (LASSO) was used to select variables for the early prediction of DVT in trauma patients. The DVT risk assessment score (DRAS) was constructed by incorporating related features based on the LASSO analysis and nomogram prediction model. Further, the trauma patients were divided into various risk groups according to the DRAS. The incidence of lower extremity DVT was compared between groups and the discrimination of the DRAS was assessed using the area under the curve (AUC). Results: Based on the LASSO method, eight variables (age, injury severity score, body mass index, D-dimer level, fibrin degradation products, prothrombin time, prealbumin level, and hemoglobin level) were included in the DRAS. A total of 166 trauma patients were enrolled in this prospective study. Increased risk of DVT after trauma was related to higher DRAS. The area under the receiver operating characteristic (ROC) curve for the DRAS was 0.890(0.840–0.939) in the validation cohort. Moreover, the discriminatory capacity of the DRAS was superior to that of each variable independently and the Modified Wells score (P<0.05). Conclusions: We developed and prospectively validated the DRAS to predict the risk of lower extremity DVT among trauma patients, which may facilitate early identification of high-risk patients.

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Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650252 ◽

1996 ◽

Vol 75 (02) ◽

pp. 242-245 ◽

Cited By ~ 20

Author(s):

Marie Magnusson ◽

Bengt I Eriksson ◽

Peter Kãlebo ◽

Ramon Sivertsson

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Doppler Ultrasound ◽

Predictive Value ◽

Screening Method ◽

Colour Doppler ◽

Vein Thrombosis ◽

Colour Doppler Ultrasound ◽

Asymptomatic Patients ◽

Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

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Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500206 ◽

2000 ◽

Vol 15 (2) ◽

pp. 71-74 ◽

Cited By ~ 4

Author(s):

O. Agu ◽

A. Handa ◽

G Hamilton ◽

D. M. Baker

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Teaching Hospital ◽

Surgical Patients ◽

Thrombosis Prophylaxis ◽

High Risk Patients ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Risk Patients ◽

Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

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INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i5.24939 ◽

2018 ◽

Vol 11 (5) ◽

pp. 377

Author(s):

Morteza Habibi Moghadam ◽

Marzieh Asadizaker ◽

Simin Jahani ◽

Elham Maraghi ◽

Hakimeh Saadatifar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Deep Vein Thrombosis ◽

Intervention Group ◽

Control Group ◽

Nursing Interventions ◽

Vein Thrombosis ◽

Wells Score ◽

Deep Vein ◽

Pitting Edema

Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

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