Article Figures & Data
Tables
- Table 1
Hospitals’ guidelines for DVT prophylaxis within trauma patients
Hospital 1 Mechanical compression devices and TEDS applied, unless patient suffered leg fracture or has poor arterial perfusion of legs Trauma patients with multiple DVT risk factors, especially prior DVT, should receive subcutaneous heparin 5000 units every 12 hours.* Spinal cord injury patients should receive subcutaneous heparin, adjusted to maintain a PTT=35–40. Treatment may be discontinued when spasticity develops. Risk factors for DVT include: ▸ Age >40+bed rest >3 days
▸ Prior DVT
▸ Coma (GCS<7)
▸ Spine fracture
▸ Quadriplegia/paraplegia
▸ Pelvic fracture
▸ Leg/hip fracture
▸ Cancer
▸ CHF
▸ General surgery+bed rest
▸ Lupus anticoagulant
▸ Hereditable coagulation deficiencies
▸ Nephrotic syndrome
▸ Stroke
▸ Urological surgery
▸ Myocardial infarction
▸ Older age
▸ Obesity
▸ Oral contraception
▸ Pregnancy/postpartum
▸ Ulcerative colitis/inflammatory bowel disease
▸ Sepsis
▸ Myeloproliferative disease
▸ Varicose veins
▸ Smoking
Hospital 2 Patients >16 years—mechanical compression devices and TEDS applied to uninjured leg or both legs if possible All patients not at risk for bleeding with anticipated stay >48 hours and non-ambulatory should receive chemical prophylaxis. Patients initially at risk for further bleeding can have chemical prophylaxis started within 72 hours of injury. Trauma patients without contraindications should receive enoxaparin (30 mg, subcutaneous, twice per day) unless a dose adjustment is needed due to geriatric age, weight, or renal failure. Patients with epidural catheters and ICP monitors will receive 40 mg of subcutaneous enoxaparin once a day. Enoxaparin is held 24 hours prior to placement of epidural or ICP. Preoperative chemical prophylaxis will not be held for surgical procedures unless requested by surgeon. Hospital 3 No formal prophylaxis protocol. Treated per physician opinion *Per communication with the trauma services department, the current practice has changed without an update to the protocol; it is standard procedure to use enoxaparin for chemical prophylaxis.
CHF, congestive heart failure; GCS, Glasgow Coma Scale; ICP, intracranial pressure; PTT, partial thromboplastin time; TEDS, thromboembolism deterrent stockings.
- Table 2
Risk factors and outcomes by diabetes type
Clinical characteristics, n (%) No diabetes (n=24 103) IDDM (n=779) NIDDM (n=2052) p* Hospital† <0.001 1 11 909 (90.9%) 426 (3.3%) 771 (5.9%) 2 8034 (87.8%) 334 (3.7%) 781 (8.5%) 3 4160 (88.9%) 19 (0.4%) 500 (10.7%) Elderly, ≥65 years 8322 (34.5%) 439 (56.4%) 1296 (63.2%) <0.001 Male 14 092 (58.5%) 430 (55.2%) 1081 (52.7%) <0.001 Smoker 4088 (17.0%) 87 (11.2%) 193 (9.4%) <0.001 Alcohol abuse 2925 (12.1%) 51 (6.6%) 115 (5.6%) <0.001 Pre-existing comorbidities‡ 15 558 (64.6%) 690 (88.6%) 1869 (91.1%) <0.001 Coagulopathy 1747 (7.3%) 115 (14.8%) 310 (15.1%) <0.001 Obesity 1147 (4.8%) 111 (14.3%) 285 (13.9%) <0.001 Cancer 80 (0.3%) 3 (0.4%) 9 (0.4%) 0.71 Cardiac disease 2347 (9.7%) 162 (20.8%) 526 (25.6%) <0.001 Cerebrovascular accident 536 (2.2%) 50 (6.4%) 114 (5.6%) <0.001 Pregnancy 143 (0.6%) 0 (0%) 1 (0.1%) 0.001 ISS≥16§ 4912 (20.4%) 112 (14.4%) 428 (20.9%) <0.001 Hip fracture 2722 (11.3%) 127 (16.3%) 319 (15.6%) <0.001 Region of injury Neck/spine¶ 4105 (17.0%) 117 (15.0%) 278 (13.6%) <0.001 Abdominal/pelvic¶ 1808 (7.5%) 23 (3.0%) 87 (4.2%) <0.001 Chest¶ 4741 (19.7%) 135 (17.3%) 360 (17.5%) 0.02 External¶ 415 (1.7%) 8 (1.0%) 19 (0.9%) 0.01 Limb¶ 11 453 (47.5%) 414 (53.2%) 970 (47.3%) 0.01 Face¶ 1774 (7.4%) 28 (3.6%) 90 (4.4%) <0.001 Head¶ 6888 (28.6%) 170 (21.8%) 578 (28.2%) <0.001 Multiple injuries 6278 (26.1%) 134 (17.2%) 384 (18.7%) <0.001 Surgical procedure 10 638 (44.1%) 360 (46.2%) 810 (39.5%) <0.001 Placement of a central line 1773 (7.4%) 65 (8.3%) 173 (8.4%) 0.13 Mechanical ventilation 2597 (10.8%) 77 (9.9%) 184 (9.0%) 0.03 Hospital LOS, median (IQR) 3 (2–6) 4 (3–7) 4 (2–6) <0.001 Admitted to ICU 7854 (32.6%) 252 (32.4%) 683 (33.3%) 0.80 Infection 450 (1.9%) 18 (2.3%) 53 (2.6%) 0.06 No complications 21 496 (89.2%) 667 (85.6%) 1788 (87.1%) <0.001 VTE 523 (2.2%) 28 (3.6%) 50 (2.4%) 0.02 DVT 422 (1.8%) 24 (3.1%) 41 (2.0%) 0.02 PE 135 (0.6%) 5 (0.6%) 12 (0.6%) 0.95 In-hospital death§ 791 (3.3%) 26 (3.3%) 86 (4.2%) 0.09 *Significant p values (p<0.05) are displayed in bold.
†Row percent presented for hospital.
‡Pre-existing comorbidities does not include diabetes.
§Missing ISS on 77 patients and death outcome on 1 patient.
¶AIS≥2.
AIS, Abbreviated Injury Score; DVT, deep vein thrombosis; ICU, intensive care unit; IDDM, insulin-dependent diabetes mellitus; ISS, Injury Severity Score; LOS, length of stay; NIDDM, non-insulin-dependent diabetes mellitus; PE, pulmonary embolism; VTE, venous thromboembolism.
- Table 3
Multivariate predictors of a venous thromboembolism, all ages
AOR 95% CI p* Model 1: any diabetes and adjustment for covariates Any diabetes 1.15 0.89 to 1.49 0.29 Age≥65 1.67 1.37 to 2.02 <0.001 Male 1.39 1.15 to 1.68 0.001 Obesity 1.63 1.23 to 2.16 0.001 ISS≥16 1.42 1.12 to 1.81 0.005 Limb injury† 1.58 1.28 to 1.95 <0.001 Face injury† 0.67 0.49 to 0.91 0.01 Multiple injuries 1.40 1.11 to 1.77 0.01 Surgical procedure 3.55 2.78 to 4.52 <0.001 Hip injury† 1.32 1.02 to 1.71 0.03 Placement of a central line 1.55 1.21 to 1.99 0.001 Mechanical ventilation 3.48 2.70 to 4.47 <0.001 Infection 2.00 1.47 to 2.72 <0.001 Model 2: IDDM and adjustment for covariates IDDM 1.43 0.95 to 2.15 0.09 Age≥65 1.71 1.39 to 2.10 <0.001 Male 1.49 1.23 to 1.82 <0.001 Obesity 1.68 1.24 to 2.27 0.001 ISS≥16 1.40 1.09 to 1.81 0.01 Limb injury† 1.57 1.26 to 1.96 <0.001 Face injury† 0.66 0.48 to 0.91 0.01 Multiple injuries 1.40 1.09 to 1.79 0.01 Surgical procedure 3.44 2.67 to 4.43 <0.001 Hip injury† 1.38 1.05 to 1.80 0.02 Placement of a central line 1.54 1.19 to 2.00 0.001 Infection 2.08 1.51 to 2.85 <0.001 Mechanical ventilation 3.53 2.71 to 4.59 <0.001 Model 3: NIDDM and adjustment for covariates NIDDM 1.03 0.75 to 1.40 0.88 Age≥65 1.77 1.47 to 2.13 <0.001 Male 1.35 1.12 to 1.64 0.002 Obesity 1.65 1.23 to 2.21 0.001 ISS≥16 1.65 1.32 to 2.06 <0.001 Limb injury† 1.90 1.56 to 2.32 <0.001 Surgical procedure 3.62 2.83 to 4.61 <0.001 Placement of a central line 1.54 1.19 to 1.98 0.001 Mechanical ventilation 3.48 2.69 to 4.50 <0.001 Infection 2.00 1.46 to 2.74 <0.001 *Significant p values (p<0.05) are displayed in bold.
†AIS≥2.
AIS, Abbreviated Injury Score; AOR, adjusted OR; IDDM, insulin-dependent diabetes mellitus; ISS, Injury Severity Score; NIDDM, non-insulin-dependent diabetes mellitus.
- Table 4
Multivariate predictors of a venous thromboembolism, patients under the age of 65 years
AOR 95% CI p* Model 4: any diabetes and adjustment for covariates Any diabetes 1.41 0.95 to 2.09 0.08 Male 1.51 1.16 to 1.96 0.002 Obesity 1.76 1.25 to 2.47 0.001 ISS≥16 1.58 1.19 to 2.09 0.002 Limb injury† 1.85 1.44 to 2.37 <0.001 Surgical procedure 3.38 2.42 to 4.72 <0.001 Hip injury† 1.57 1.05 to 2.36 0.03 Placement of a central line 1.53 1.13 to 2.08 0.01 Mechanical ventilation 4.04 2.94 to 5.53 <0.001 Infection 2.35 1.62 to 3.43 <0.001 Model 5: IDDM and adjustment for covariates IDDM 1.86 1.01 to 3.41 0.045 Male 1.52 1.16 to 2.00 0.003 Obesity 1.78 1.24 to 2.55 0.002 ISS≥16 1.53 1.14 to 2.05 0.005 Limb injury† 1.79 1.39 to 2.31 <0.001 Surgical procedure 3.42 2.42 to 4.83 <0.001 Hip injury† 1.63 1.07 to 2.46 0.02 Placement of a central line 1.49 1.09 to 2.04 0.01 Mechanical ventilation 4.06 2.93 to 5.62 <0.001 Infection 2.53 1.73 to 3.70 <0.001 Model 6: NIDDM and adjustment for covariates NIDDM 1.21 0.74 to 1.99 0.44 Male 1.45 1.11 to 1.90 0.01 Obesity 1.76 1.24 to 2.50 0.002 ISS≥16 1.63 1.22 to 2.17 0.001 Limb injury† 1.93 1.49 to 2.48 <0.001 Surgical procedure 3.28 2.33 to 4.60 <0.001 Hip injury† 1.56 1.02 to 2.37 0.04 Placement of a central line 1.49 1.09 to 2.03 0.01 Mechanical ventilation 4.09 2.97 to 5.64 <0.001 Infection 2.26 1.54 to 3.32 <0.001 *Significant p values (p<0.05) are displayed in bold.
†AIS≥2.
AIS, Abbreviated Injury Score; AOR, adjusted OR; IDDM, insulin-dependent diabetes mellitus; ISS, Injury Severity Score; NIDDM, non-insulin-dependent diabetes mellitus.
- Table 5
Multivariate predictors of a venous thromboembolism, patients 65 years and older
AOR 95% CI p* Model 7: any diabetes and adjustment for covariates Any diabetes 1.06 0.76 to 1.48 0.74 Multiple injuries 1.74 1.28 to 2.36 <0.001 Surgical procedure 4.78 3.46 to 6.59 <0.001 Placement of a central line 1.76 1.15 to 2.71 0.01 Mechanical ventilation 2.77 1.86 to 4.13 <0.001 Model 8: IDDM and adjustment for covariates IDDM 1.25 0.72 to 2.17 0.43 Male 1.48 1.10 to 1.98 0.01 Limb injuries† 1.49 1.07 to 2.09 0.02 Multiple injuries 1.54 1.10 to 2.17 0.01 Surgical procedure 3.85 2.67 to 5.54 <0.001 Placement of a central line 1.82 1.14 to 2.91 0.01 Mechanical ventilation 2.94 1.87 to 4.61 <0.001 Model 9: NIDDM and adjustment for covariates NIDDM 0.98 0.66 to 1.45 0.91 Multiple injuries 1.84 1.34 to 2.52 0.001 Surgical procedure 5.01 3.59 to 7.01 <0.001 Placement of a central line 1.70 1.09 to 2.64 0.02 Mechanical ventilation 2.72 1.80 to 4.10 <0.001 *Significant p values (p<0.05) are displayed in bold.
†AIS≥2.
AIS, Abbreviated Injury Score; AOR, adjusted OR; IDDM, insulin-dependent diabetes mellitus; ISS, Injury Severity Score; NIDDM, non-insulin-dependent diabetes mellitus.
