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Ultrasound useful in detecting high rate of lower extremity DVT in trauma patients

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The use of duplex ultrasound screening can help shed light on a high rate of lower extremity deep vein thromboses in critically ill trauma cases, according to a study published in the Journal of Vascular Surgery.

"Lower extremity deep vein thrombosis (LEDVT) is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, [DVT] risk factors or pharmacologic prophylaxis," study author Amir Azarbal, MD, stated in a Society for Vascular Surgery news release. "However, previous studies have underestimated DVT rates by not including calf vein thromboses (CVDTs) and not exclusively targeting critically ill patients."

The authors performed a retrospective review of medical records for 264 patients who sustained trauma and went through an intensive care unit. The patients received duplex ultrasound screening (DUS) for LEDVT between January 2007 and December 2008. Assessment took note of the presence of injuries conferring high risk for LEDVT, as well as patient-specific DVT risk factors and low molecular weight heparin prophylaxis.

According to the release, the authors noted the American College of Chest Physician (ACCP) guidelines stratify DVT risk in trauma patients based only on injury pattern and pharmacologic prophylaxis, with screening only recommended for patients with high-risk injuries who are unable to receive pharmacologic prophylaxis.

"Current ACCP guidelines miss a substantial proportion of LEDVTs in critically ill trauma patients, especially when CVDVTs are included in the screening," Azarbal stated. "Diagnosis of these otherwise undetected DVTs can lead to therapeutic anticoagulation, IVC filter placement or continued surveillance, depending on institutional practices."

The authors found that 40 asymptomatic patients in the study (15.2%) demonstrated LEDVTs that were diagnosed through DUS screening. Twenty-four of these patients (60%) had a CVDVT, with 30% of all DVTs being diagnosed within a week of admission. Those patients who did not sustain high-risk injuries but received heparin had a 13% DVT rate - which did not differ to a significant extent from the 19.7% DVT rate in high-risk injury patients who did not receive heparin.

"This study shows that DUS screening appears to be a useful adjunct to current protocols of DVT prevention, detection and treatment in trauma ICUs," the authors wrote, further recommending routine DUS - as well as early and ongoing surveillance of all critically ill trauma patients for all LEDVTs regardless of injury patterns, DVT risk factors or presence of pharmacologic prophylaxis.

Reference:

• Azarbal A, Rowell S, Lewis J, et al. Duplex ultrasound screening detects high rates of deep vein thromboses in critically ill trauma patients. J Vasc Surg. 2011. doi:10.1016/j.jvs.2011.02.058

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