Utility of the risk assessment profile for risk stratification of venous thrombotic events for trauma patients
ABSTRACT BACKGROUND: Trauma patients are at risk for the development of venous thromboembolism (VTE). The purpose of this study was to validate the Risk Assessment Profile (RAP) as a tool for stratifying the risk of VTE. METHODS: RAP scores were calculated in a retrospective cohort analysis for all trauma patients aged 13 years or older admitted in 2003 and 2006 and hospitalized longer than 48 hours. Association of RAP with VTE, sensitivity, specificity, and receiver operating characteristic curve were included in the analysis. RESULTS: Of 2,281 patients, deep vein thrombosis (DVT) developed in 239 (10.5%) and pulmonary embolism (PE) developed in 34 (1.5%). In moderate- and high-risk patients, the RAP had a sensitivity of .82 and a specificity of .57. Identification of VTE for high-risk patients had a sensitivity .15 and a specificity of .97. The incidence of VTE increased significantly with risk level regardless of mechanism of injury. CONCLUSIONS: The RAP score is highly associated with VTE in trauma patients regardless of mechanism of injury and is a valid risk assessment tool.
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ABSTRACT: In trauma patients, Enoxaparin (a low molecular weight heparin, LMWH) prophylaxis for venous thromboembolism (VTE) risk reduction is unproven. Cohort analysis conducted consisting of all trauma patients age >13 admitted to Level-I trauma center and hospitalized >48 hours. VTE risk determined by the Risk Assessment Profile. High risk patients received LMWH unless contraindicated, while low and moderate risk patients received LMWH at attending surgeon's discretion. Odds ratio for VTE by logistic regression. VTE incidence, relative risk (RR), and number needed to treat (NNT) to prevent deep vein thrombosis (DVT) or pulmonary embolism determined by risk category. Cohort consisted of 2,281 patients (1,211 low, 979 moderate, 91 high risks). VTE occured in 254 patients (11.1%). High-risk patients had significantly higher VTE incidence, odds ratio = 31.8 (P < .001). VTE was significantly reduced in high-risk patients receiving LMWH versus those who did not (.26 vs .53, P = .02). Among moderate and high risk, prophylactic LMWH reduced the incidence of pulmonary embolism (RR = .19, NNT = 40.4, P = .01), and trended toward reduced DVT incidence (RR = .81, NNT = 27.3, P = .15). LMWH lowered DVT incidence (RR = .52, NNT = 4.1, P = .03) in high risk patients. Prophylactic LMWH is associated with reduction of VTE in trauma patients.American journal of surgery 01/2014; 207(5). DOI:10.1016/j.amjsurg.2013.12.010 · 2.41 Impact Factor