Predictors of Posttraumatic Deep Vein Thrombosis (DVT): Hospital Practice Versus Patient Factors-An Analysis of the National Trauma Data Bank (NTDB)
Predictors of Posttraumatic Deep Vein Thrombosis (DVT): Hospital Practice Versus Patient Factors-An Analysis of the National Trauma Data Bank (NTDB)
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DOI：
10.1097/ta.0b013e3181991adc
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发表时间：
2009-04-01
影响因子：
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通讯作者：
Pronovost, Peter J.
中科院分区：
文献类型：
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作者：
Haut, Elliott R.;Chang, David C.;Pronovost, Peter J.
目的：进行更多双重超声检查的创伤中心报告更多的深静脉血栓 (DVT)。然而，尚不确定这是否是由于医院实践或患者特征和病例组合的差异所致。我们假设，进入更频繁地使用双功能超声的创伤中心，可以独立预测个体患者的 DVT 报告，并控制患者水平的风险因素。方法：我们分析了来自创伤中心的向国家创伤数据库 (v6.2) 报告至少一项血管超声和一项 DVT 的患者。由于国家创伤数据库不包含有关医院双重监测实践的数据，因此我们将“筛查”创伤中心定义为对超过 2% 的患者进行超声检查的中心。主要结局指标是 DVT 诊断。使用患者水平的危险因素协变量以及医院复工率进行多重逻辑回归，以比较“筛查”与“非筛查”创伤中心的患者。通过改变双工率截止值、结果测量和患者群体进行敏感性分析。结果。 492,496 名患者中约有一半被送入“筛查”创伤中心。未经调整的 DVT 发生率是原来的三倍。 “筛查”创伤中心患者的比例较高（1.18% vs. 0.35%，p < 0.001）。年龄 >= 40 岁、四肢损伤、头部损伤、呼吸机使用第 2-3 天、静脉损伤和大手术与 DVT 诊断独立相关。入院“筛查”创伤中心与 DVT 报告的较高可能性独立相关（比值比，2.16；95% 置信区间，1.07-4.34）。敏感性分析未发现定性差异。结论。创伤中心超声检查是个体患者 DVT 诊断的独立预测因素，可控制患者水平的危险因素。这些中心 DVT 发生率升高是由于监测偏差造成的。在缺乏标准化监测的情况下，医院 DVT 发生率是一种不恰当的创伤后护理质量衡量标准。
Objective: Trauma centers that perform more duplex ultrasounds report more deep vein thromboses (DVT). However, it is uncertain if this is due to variations in hospital practices or patient characteristics and case mix. We hypothesize that admission to trauma centers that use duplex ultrasound more frequently, independently predicts DVT reporting for individual patients, controlling for patient-level risk factors.Methods: we analyzed patients from trauma centers reporting at least one vascular ultrasound and one DVT to the National Trauma Data Bank (v6.2). Because National Trauma Data Bank contains no data on hospital duplex surveillance practice, we defined "screening" trauma centers as those performing ultrasound on more than 2% of patients. The primary outcome measure was DVT diagnosis. Multiple logistic regression was performed, using patient-level risk factor covariates as well as hospital duplex rate to compare patients at "screening" versus "non-screening" trauma centers. Sensitivity analysis was performed by varying duplex rate cutoff, outcome measure, and patient population.Results. Approximately half of 492,496 patients were admitted to "screening" trauma centers. Unadjusted DVT rate was threefold. higher in "screening" trauma center patients (1.18% vs. 0.35%, p < 0.001). Age >= 40 years, extremity injury, head injury, ventilator days 2-3, venous injury and major surgery were independently associated with DVT diagnosis. "Screening" trauma center admission was independently associated with a higher likelihood of DVT reporting (odds ratio, 2.16; 95% confidence interval, 1.07-4.34). No qualitative differences were identified on sensitivity analyses.Conclusions. Trauma center ultrasound practice is an independent predictor of DVT diagnosis for individual patients, controlling for patient-level risk factors. Elevated DVT rates at these centers are due to surveillance bias. In the absence of standardized surveillance, hospital DVT rate is an inappropriate quality of care measure after trauma.