Venous thromboembolism after severe trauma: Incidence, risk factors and outcome
Introduction
Venous thromboembolic events (VTEs) comprise deep vein thrombosis (DVT) and pulmonary embolism (PE) and represent a significant cause of death, disability and discomfort after trauma-associated hospitalisation. While DVT may present clinically silent, PE is the third most common cause of death in patients that survive the first 24 h after trauma.10, 11, 24 The information on the frequency of VTEs among hospitalised patients after trauma varies widely, ranging from less than 1% up to 58% depending upon the demographics of the study population, the nature of the injuries and other factors.4, 17, 20, 28 The increased survival of severely injured patients together with the aging population may implicate an increasing risk of VTEs after trauma.
The current literature focuses on practice guidelines with respect to diagnostic procedures and the prevention of post-traumatic VTEs. In this context, the identification of risk factors has proven to be useful to define high-risk patients.6, 7, 8, 9, 10, 13, 18, 19, 26, 27, 28, 29 The recognition of potential risk factors and corresponding prophylaxis appears mandatory for all trauma patients.
The aim of our study was to determine to what extent VTEs occur in hospitalised trauma patients and whether their occurrence was associated with: (a) the magnitude and pattern of injury, (b) therapeutic interventions and (c) outcome. In addition multivariate logistic regression was performed to identify risk factors for VTEs after trauma. For this purpose, we reviewed datasets of patients from the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) comprising data from more than 35,000 multiply injured patients.
Section snippets
The Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR-DGU)
The TR-DGU2 was founded in 1993 by the German Society of Trauma Surgery (DGU) for anonymous and standardised documentation of data on trauma patients requiring intensive care. Until 2007, data from a total of 35,664 trauma patients have been entered into the registry. In 2002, the online documentation system of the registry was introduced and extended the registry by additional parameters. Currently, 145 hospitals are affiliated with the TR-DGU, mostly from Germany (n = 128) (www.traumaregister.de
Results
Of the 14,679 patients registered in the relevant study period (2005–2007), 3797 partially incomplete data forms were excluded from further analysis. Two thousand nine hundred and forty-five patients were excluded according to the inclusion/exclusion criteria.
Thus, a total of 7937 trauma patients with complete datasets were retrieved from the registry and analysed. For 146/7937 patients a VTE during post-traumatic hospitalisation was reported. This corresponded to an overall frequency for VTEs
Discussion
The present study was conducted to assess the overall frequency of VTEs in hospitalised trauma patients, to elucidate potential risk factors for the development of VTEs after severe trauma and to evaluate their effects on outcome using a large country-wide population-based registry containing data from more than 35,000 injured patients in Germany.
In our population the frequency of VTEs after trauma-associated hospitalisation was 1.8%. Similar frequencies from injured patients have been reported
Conflict of interest
None.
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2023, American Journal of SurgeryCitation Excerpt :It is well-established that trauma is associated with increased rates of venous thromboembolism (VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE). Published rates of VTE complications in injured patients ranges from <1% to 100% depending upon the injury severity and pattern, and VTE prophylaxis practices.13–16 For spinal trauma patients specifically, the rate of VTE complications has been reported as 4% in those with spinal cord injury,17 8% for those patients managed operatively18 and 5% for those managed non-operatively.19
- 1
These two authors are joint first authors and contributed equally to the study.
- 2
Committee on Emergency Medicine, Intensive and Trauma Care (Sektion NIS) of the German Society for Trauma Surgery (DGU).