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  1. Venous thromboembolism in the high-risk trauma patient : Do risks justify aggressive screening and prophylaxis ? Commentary.

    Article, Communication - En anglais

    Annual Meeting of the American Association for the Surgery of Trauma. Houston, Texas (USA), 1996/09/19.

    Objective 

    Deep venous thrombosis (DVT) and pulmonary embolism (PE) are considered to be a major source of morbidity and mortality among trauma patients.

    Several reports have identified high-risk patients with recommendations for management ranging from frequent duplex scanning to placement of prophylactic inferior vena cava (IVC) filters.

    We reviewed our experience with a large trauma population to determine whether such approaches are justified.

    Methods 

    We analyzed 2,868 consecutive trauma admissions over 22 months and identified 280 patients (10%) in high-risk groups who survived = 48 hours : (1) severe closed head injury with mechanical ventilation = 72 hours, (2) closed head injury with lower extremity fractures, (3) spinal column/cord injury, (4) combined pelvic and lower extremity fractures, and (5) major infrarenal venous injuries.

    The remaining nonthermal injury patients constituted the low-risk group.

    Results 

    There were 280 high-risk patients, 213 of whom (76%) received prophylaxis with compression therapy.

    There were 12 cases of DVT (5%) with four nonfatal PE (1.4%). Six patients (2%) had therapeutic IVC filters inserted and only one patient had prophylactic placement.

    There were 38 deaths in this group, attributable primarily to severe closed head injury or spine injuries, and none were caused by PE.

    In the 2,249 low-risk patients, there were three cases of DVT (0.1%, p<0.05 vs. high risk) and no PE (p<0.05 vs. high risk). (...)

    Mots-clés Pascal : Traumatisme, Facteur risque, Complication, Thrombose profonde, Veine, Homme, Epidémiologie, Incidence, Mortalité, Thromboembolie, Coût, Prévention, Filtre, Veine cave inférieure, Traitement, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Veine pathologie

    Mots-clés Pascal anglais : Trauma, Risk factor, Complication, Deep vein thrombosis, Vein, Human, Epidemiology, Incidence, Mortality, Thromboembolism, Costs, Prevention, Filter, Inferior vena cava, Treatment, Cardiovascular disease, Vascular disease, Venous disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0251600

    Code Inist : 002B12B03. Création : 11/06/1997.