Thromboembolism after trauma - An analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank
Thromboembolism after trauma - An analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank
复制标题
DOI：
10.1097/01.sla.0000137138.40116.6c
复制
发表时间：
2004-09-01
影响因子：
9
通讯作者：
Speetzen, LS
中科院分区：
文献类型：
--
作者：
Knudson, MM;Ikossi, DG;Speetzen, LS
目的：静脉血栓栓塞事件（VTE）是损伤后发病和死亡的潜在可预防原因。我们假设目前静脉血栓栓塞的临床发病率相对较低，并且可以确定静脉血栓栓塞的危险因素。方法：我们向ACS国家创伤数据库查询深静脉血栓形成（DVT）和/或肺栓塞（PE）的发作情况。我们检查了131家创伤中心收治的患者的人口统计数据、静脉血栓栓塞危险因素、结局和静脉血栓栓塞预防措施。结果：在450375例患者中，1602例（0.36%）发生静脉血栓栓塞（DVT 998例，PE 522例，两者均有82例），发生率为0.36%。90%的静脉血栓栓塞患者存在与静脉血栓栓塞相关的9种危险因素中的1种。六个独立发现重大风险因素的多元逻辑回归静脉血栓栓塞是大于或等于to40岁(优势比[或]2.01;95%可信区间[CI] 1.74到2.32),下肢骨折与AIS 3(或1.92;95%可信区间1.64到2.26),头部受伤与AIS大于或等于版本(或1.24;95%可信区间1.05到1.46),通风机天> 3(或8.08;95%可信区间6.86到9.52),静脉损伤(或3.56;95%可信区间2.22到5.72),和主要操作过程(或1.53;95% CI 1.30 - 1.80)。在3883例患者中放置腔静脉过滤器，86%用于PE预防，其中包括410例没有可识别的静脉血栓栓塞危险因素的患者。结论：创伤后需要静脉血栓栓塞预防的患者可根据危险因素进行识别。应重新检查预防性腔静脉过滤器的使用情况。
Objective: Venous tromboembolic events (VTE) are potentially preventable causes of morbidity and mortality after injury. We hypothesized that the current clinical incidence of VTE is relatively low and that VTE risk factors could be identified.Methods: We queried the ACS National Trauma Data Bank for episodes of deep venous thrombosis (DVT) and/or pulmonary embolism (PE). We examined demographic data, VTE risk factors, outcomes, and VTE prophylaxis measures in patients admitted to the 131 contributing trauma centers.Results: From a total of 450,375 patients, 1602 (0.36%) had a VTE (998 DVT, 522 PE, 82 both), for an incidence of 0.36%. Ninety percent of patients with VTE had 1 of the 9 risk factors commonly associated with VTE. Six risk factors found to be independently significant in multivariate logistic regression for VTE were age greater than or equal to40 years (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.74 to 2.32), lower extremity fracture with AIS 3 (OR 1.92; 95% CI 1.64 to 2.26), head injury with AIS greater than or equal to3 (OR 1.24; 95% CI 1.05 to 1.46), ventilator days > 3 (OR 8.08; 95% CI 6.86 to 9.52), venous injury (OR 3.56; 95% CI 2.22 to 5.72), and a major operative procedure (OR 1.53; 95% CI 1.30 to 1.80). Vena cava filters were placed in 3,883 patients, 86% as PE prophylaxis, including in 410 patients without an identifiable risk factor for VTE.Conclusions: Patients who need VTE prophylaxis after trauma can be identified based on risk factors. The use of prophylactic vena cava filters should be re-examined.