The Utility of Lower Extremity Screening Duplex for the Detection of Deep Vein Thrombosis in Trauma

• Published in: The Journal of surgical research 2022-01, Vol.269, p.151-157
• Main Authors: Teichman, Amanda L., Walls, David, Choron, Rachel L., Butts, Christopher A., Krumrei, Nicole, Amro, Christopher, Swaminathan, Sneha, Arcomano, Nicholas, Parekh, Akshat, Romeo, Paul
• Format: Article
• Language: English
• Subjects: Chemoprophylaxis; Deep venous thrombosis; Risk assessment profile score; Screening duplex ultrasonography; Trauma; Venous thromboembolism
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.08.010

Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P = 0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P = 0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR = 1.48, 95% CI = 1.03-2.12). VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.