Risk factors for venous thromboembolism after acute trauma: A population-based case-cohort study
Risk factors for venous thromboembolism after acute trauma: A population-based case-cohort study
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DOI：
10.1016/j.thromres.2016.03.026
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发表时间：
2016-08-01
影响因子：
7.5
通讯作者：
Heit, John A.
中科院分区：
文献类型：
--
作者：
Park, Myung S.;Perkins, Sarah E.;Heit, John A.
背景资料：创伤后静脉血栓栓塞（VTE）的预测因素是不确定的。目的：确定急性创伤后VTE的独立预测因素：使用罗切斯特流行病学项目（REP）的资源，我们确定了所有奥姆斯特德县，明尼苏达州的居民在92天内客观诊断的急性创伤住院后的18年期间，1988-2005年的事件VTE。我们还确定了这段时间内因急性创伤住院的所有奥姆斯特德县居民，并选择了一到两名与VTE病例频率匹配的居民，这些患者的性别、事件年组和ICD-9-CM创伤代码预测了手术。在一项病例队列研究中，人口统计学，基线和时间依赖性的特征进行了测试，创伤后使用考克斯比例风险modeling.Results的预测VTE：在200例事件VTE的情况下，中位数（四分位数范围）的时间从创伤到VTE为18（6，41）天。其中，62%的病例在出院后发生VTE。在一个包括370名队列成员的多变量模型中，患者受伤时的年龄、男性、创伤死亡率预测模型（TMPM）死亡率评分反映的受伤严重程度增加、创伤前不动、软组织腿部损伤和既往浅静脉血栓形成是VTE的独立预测因素结论：我们已经确定了临床特征，可以识别急性创伤后VTE风险增加的患者，独立于手术。几乎三分之二的VTE事件发生在首次出院后（从创伤到VTE的中位时间为18天），这对目前出院后不延长VTE预防的做法提出了质疑。(C)2016由Elsevier Ltd.出版
Background: Predictors of venous thromboembolism (VTE) after trauma are uncertain.Objective: To identify independent predictors of VTE after acute trauma.Methods: Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days after hospitalization for acute trauma over the 18-year period, 1988-2005. We also identified all Olmsted County residents hospitalized for acute trauma over this time period and chose one to two residents frequency-matched to VTE cases on sex, event year group and ICD-9-CM trauma code predictive of surgery. In a case-cohort study, demographic, baseline and time-dependent characteristics were tested as predictors of VTE after trauma using Cox proportional hazards modeling.Results: Among 200 incident VTE cases, the median (interquartile range) time from trauma to VTEwas 18 (6, 41) days. Of these, 62% cases developed VTE after hospital discharge. In a multiple variable model including 370 cohort-members, patient age at injury, male sex, increasing injury severity as reflected by the Trauma Mortality Prediction Model (TMPM) Mortality Score, immobility prior to trauma, soft tissue leg injury, and prior superficial vein thrombosis were independent predictors of VTE (C-statistic = 0.78).Conclusions: We have identified clinical characteristics which can identify patients at increased risk for VTE after acute trauma, independent of surgery. Almost two thirds of all incident VTE events occurred after initial hospital discharge (18 day median time from trauma to VTE) which questions current practice of not extending VTE prophylaxis beyond hospital discharge. (C) 2016 Published by Elsevier Ltd.