Association of mechanism of injury with risk for venous thromboembolism after trauma

Charles A. Karcutskie, Jonathan P. Meizoso, Juliet J. Ray, Davis Horkan, Xiomara D. Ruiz, Carl I Schulman, Nicholas Namias, Kenneth G Proctor

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

IMPORTANCE To date, no study has assessed whether the risk of venous thromboembolism (VTE) varies with blunt or penetrating trauma. OBJECTIVE To test whether the mechanism of injury alters risk of VTE after trauma. DESIGN, SETTING, AND PARTICIPANTS A retrospective database reviewwas conducted of adults admitted to the intensive care unit of an American College of Surgeons-verified level I trauma center between August 1, 2011, and January 1, 2015, with blunt or penetrating injuries. Univariate and multivariable analyses identified independent predictors of VTE. MAIN OUTCOMES AND MEASURES Differences in risk factors for VTE with blunt vs penetrating trauma. RESULTS In 813 patients with blunt trauma (mean [SD] age, 47 [19] years) and 324 patients with penetrating trauma (mean [SD] age, 35 [15] years), the rate of VTE was 9.1% overall (104 of 1137) and similar between groups (blunt trauma, 9% [n = 73] vs penetrating trauma, 9.6% [n = 31]; P = .76). In the blunt trauma group, more patients with VTE than without VTE had abnormal coagulation results (49.3%vs 35.7%; P = .02), femoral catheters (9.6%vs 3.9%; P = .03), repair and/or ligation of vascular injury (15.1%vs 5.4%; P = .001), complex leg fractures (34.2%vs 18.5%; P = .001), Glasgow Coma Scale score less than 8 (31.5%vs 10.7%; P < .001), 4 or more transfusions (51.4%vs 17.6%; P < .001), operation time longer than 2 hours (35.6%vs 16.4%; P < .001), and pelvic fractures (43.8% vs 21.4%; P < .001); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (13 [6] vs 8 [4]; P .001). However, with multivariable analysis, only receiving 4 or more transfusions (odds ratio [OR], 3.47; 95%CI, 2.04-5.91), Glasgow Coma Scale score less than 8 (OR, 2.75; 95%CI, 1.53-4.94), and pelvic fracture (OR, 2.09; 95%CI, 1.23-3.55) predicted VTE, with an area under the receiver operator curve of 0.730. In the penetrating trauma group, more patients with VTE than without VTE had abnormal coagulation results (64.5%vs 44.4%; P = .03), femoral catheters (16.1%vs 5.5%; P = .02), repair and/or ligation of vascular injury (54.8%vs 25.3%; P < .001), 4 or more transfusions (74.2%vs 39.6%; P < .001), operation time longer than 2 hours (74.2%vs 50.5%; P = .01), Abbreviated Injury Score for the abdomen greater than 2 (64.5%vs 42.3%; P = .02), and were aged 40 to 59 years (41.9% vs 23.2%; P = .02); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (12 [4] vs 7 [4]; P < .001). However, with multivariable analysis, only repair and/or ligation of vascular injury (OR, 3.32; 95%CI, 1.37-8.03), Abbreviated Injury Score for the abdomen greater than 2 (OR, 2.77; 95%CI, 1.19-6.45), and age 40 to 59 years (OR, 2.69; 95%CI, 1.19-6.08) predicted VTE, with an area under the receiver operator curve of 0.760. CONCLUSIONS AND RELEVANCE Although rates of VTE are the same in patients who experienced blunt and penetrating trauma, the independent risk factors for VTE are different based on mechanism of injury. This finding should be a consideration when contemplating prophylactic treatment protocols.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalJAMA Surgery
Volume152
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Venous Thromboembolism
Wounds and Injuries
Odds Ratio
Vascular System Injuries
Ligation
Glasgow Coma Scale
Thigh
Abdomen
Catheters
Trauma Centers
Clinical Protocols
Intensive Care Units
Leg

ASJC Scopus subject areas

  • Surgery

Cite this

Association of mechanism of injury with risk for venous thromboembolism after trauma. / Karcutskie, Charles A.; Meizoso, Jonathan P.; Ray, Juliet J.; Horkan, Davis; Ruiz, Xiomara D.; Schulman, Carl I; Namias, Nicholas; Proctor, Kenneth G.

In: JAMA Surgery, Vol. 152, No. 1, 01.01.2017, p. 35-40.

Research output: Contribution to journalArticle

Karcutskie, Charles A. ; Meizoso, Jonathan P. ; Ray, Juliet J. ; Horkan, Davis ; Ruiz, Xiomara D. ; Schulman, Carl I ; Namias, Nicholas ; Proctor, Kenneth G. / Association of mechanism of injury with risk for venous thromboembolism after trauma. In: JAMA Surgery. 2017 ; Vol. 152, No. 1. pp. 35-40.
@article{d2fdb7f84ed649c79828e0bcaa30e967,
title = "Association of mechanism of injury with risk for venous thromboembolism after trauma",
abstract = "IMPORTANCE To date, no study has assessed whether the risk of venous thromboembolism (VTE) varies with blunt or penetrating trauma. OBJECTIVE To test whether the mechanism of injury alters risk of VTE after trauma. DESIGN, SETTING, AND PARTICIPANTS A retrospective database reviewwas conducted of adults admitted to the intensive care unit of an American College of Surgeons-verified level I trauma center between August 1, 2011, and January 1, 2015, with blunt or penetrating injuries. Univariate and multivariable analyses identified independent predictors of VTE. MAIN OUTCOMES AND MEASURES Differences in risk factors for VTE with blunt vs penetrating trauma. RESULTS In 813 patients with blunt trauma (mean [SD] age, 47 [19] years) and 324 patients with penetrating trauma (mean [SD] age, 35 [15] years), the rate of VTE was 9.1{\%} overall (104 of 1137) and similar between groups (blunt trauma, 9{\%} [n = 73] vs penetrating trauma, 9.6{\%} [n = 31]; P = .76). In the blunt trauma group, more patients with VTE than without VTE had abnormal coagulation results (49.3{\%}vs 35.7{\%}; P = .02), femoral catheters (9.6{\%}vs 3.9{\%}; P = .03), repair and/or ligation of vascular injury (15.1{\%}vs 5.4{\%}; P = .001), complex leg fractures (34.2{\%}vs 18.5{\%}; P = .001), Glasgow Coma Scale score less than 8 (31.5{\%}vs 10.7{\%}; P < .001), 4 or more transfusions (51.4{\%}vs 17.6{\%}; P < .001), operation time longer than 2 hours (35.6{\%}vs 16.4{\%}; P < .001), and pelvic fractures (43.8{\%} vs 21.4{\%}; P < .001); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (13 [6] vs 8 [4]; P .001). However, with multivariable analysis, only receiving 4 or more transfusions (odds ratio [OR], 3.47; 95{\%}CI, 2.04-5.91), Glasgow Coma Scale score less than 8 (OR, 2.75; 95{\%}CI, 1.53-4.94), and pelvic fracture (OR, 2.09; 95{\%}CI, 1.23-3.55) predicted VTE, with an area under the receiver operator curve of 0.730. In the penetrating trauma group, more patients with VTE than without VTE had abnormal coagulation results (64.5{\%}vs 44.4{\%}; P = .03), femoral catheters (16.1{\%}vs 5.5{\%}; P = .02), repair and/or ligation of vascular injury (54.8{\%}vs 25.3{\%}; P < .001), 4 or more transfusions (74.2{\%}vs 39.6{\%}; P < .001), operation time longer than 2 hours (74.2{\%}vs 50.5{\%}; P = .01), Abbreviated Injury Score for the abdomen greater than 2 (64.5{\%}vs 42.3{\%}; P = .02), and were aged 40 to 59 years (41.9{\%} vs 23.2{\%}; P = .02); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (12 [4] vs 7 [4]; P < .001). However, with multivariable analysis, only repair and/or ligation of vascular injury (OR, 3.32; 95{\%}CI, 1.37-8.03), Abbreviated Injury Score for the abdomen greater than 2 (OR, 2.77; 95{\%}CI, 1.19-6.45), and age 40 to 59 years (OR, 2.69; 95{\%}CI, 1.19-6.08) predicted VTE, with an area under the receiver operator curve of 0.760. CONCLUSIONS AND RELEVANCE Although rates of VTE are the same in patients who experienced blunt and penetrating trauma, the independent risk factors for VTE are different based on mechanism of injury. This finding should be a consideration when contemplating prophylactic treatment protocols.",
author = "Karcutskie, {Charles A.} and Meizoso, {Jonathan P.} and Ray, {Juliet J.} and Davis Horkan and Ruiz, {Xiomara D.} and Schulman, {Carl I} and Nicholas Namias and Proctor, {Kenneth G}",
year = "2017",
month = "1",
day = "1",
doi = "10.1001/jamasurg.2016.3116",
language = "English (US)",
volume = "152",
pages = "35--40",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - Association of mechanism of injury with risk for venous thromboembolism after trauma

AU - Karcutskie, Charles A.

AU - Meizoso, Jonathan P.

AU - Ray, Juliet J.

AU - Horkan, Davis

AU - Ruiz, Xiomara D.

AU - Schulman, Carl I

AU - Namias, Nicholas

AU - Proctor, Kenneth G

PY - 2017/1/1

Y1 - 2017/1/1

N2 - IMPORTANCE To date, no study has assessed whether the risk of venous thromboembolism (VTE) varies with blunt or penetrating trauma. OBJECTIVE To test whether the mechanism of injury alters risk of VTE after trauma. DESIGN, SETTING, AND PARTICIPANTS A retrospective database reviewwas conducted of adults admitted to the intensive care unit of an American College of Surgeons-verified level I trauma center between August 1, 2011, and January 1, 2015, with blunt or penetrating injuries. Univariate and multivariable analyses identified independent predictors of VTE. MAIN OUTCOMES AND MEASURES Differences in risk factors for VTE with blunt vs penetrating trauma. RESULTS In 813 patients with blunt trauma (mean [SD] age, 47 [19] years) and 324 patients with penetrating trauma (mean [SD] age, 35 [15] years), the rate of VTE was 9.1% overall (104 of 1137) and similar between groups (blunt trauma, 9% [n = 73] vs penetrating trauma, 9.6% [n = 31]; P = .76). In the blunt trauma group, more patients with VTE than without VTE had abnormal coagulation results (49.3%vs 35.7%; P = .02), femoral catheters (9.6%vs 3.9%; P = .03), repair and/or ligation of vascular injury (15.1%vs 5.4%; P = .001), complex leg fractures (34.2%vs 18.5%; P = .001), Glasgow Coma Scale score less than 8 (31.5%vs 10.7%; P < .001), 4 or more transfusions (51.4%vs 17.6%; P < .001), operation time longer than 2 hours (35.6%vs 16.4%; P < .001), and pelvic fractures (43.8% vs 21.4%; P < .001); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (13 [6] vs 8 [4]; P .001). However, with multivariable analysis, only receiving 4 or more transfusions (odds ratio [OR], 3.47; 95%CI, 2.04-5.91), Glasgow Coma Scale score less than 8 (OR, 2.75; 95%CI, 1.53-4.94), and pelvic fracture (OR, 2.09; 95%CI, 1.23-3.55) predicted VTE, with an area under the receiver operator curve of 0.730. In the penetrating trauma group, more patients with VTE than without VTE had abnormal coagulation results (64.5%vs 44.4%; P = .03), femoral catheters (16.1%vs 5.5%; P = .02), repair and/or ligation of vascular injury (54.8%vs 25.3%; P < .001), 4 or more transfusions (74.2%vs 39.6%; P < .001), operation time longer than 2 hours (74.2%vs 50.5%; P = .01), Abbreviated Injury Score for the abdomen greater than 2 (64.5%vs 42.3%; P = .02), and were aged 40 to 59 years (41.9% vs 23.2%; P = .02); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (12 [4] vs 7 [4]; P < .001). However, with multivariable analysis, only repair and/or ligation of vascular injury (OR, 3.32; 95%CI, 1.37-8.03), Abbreviated Injury Score for the abdomen greater than 2 (OR, 2.77; 95%CI, 1.19-6.45), and age 40 to 59 years (OR, 2.69; 95%CI, 1.19-6.08) predicted VTE, with an area under the receiver operator curve of 0.760. CONCLUSIONS AND RELEVANCE Although rates of VTE are the same in patients who experienced blunt and penetrating trauma, the independent risk factors for VTE are different based on mechanism of injury. This finding should be a consideration when contemplating prophylactic treatment protocols.

AB - IMPORTANCE To date, no study has assessed whether the risk of venous thromboembolism (VTE) varies with blunt or penetrating trauma. OBJECTIVE To test whether the mechanism of injury alters risk of VTE after trauma. DESIGN, SETTING, AND PARTICIPANTS A retrospective database reviewwas conducted of adults admitted to the intensive care unit of an American College of Surgeons-verified level I trauma center between August 1, 2011, and January 1, 2015, with blunt or penetrating injuries. Univariate and multivariable analyses identified independent predictors of VTE. MAIN OUTCOMES AND MEASURES Differences in risk factors for VTE with blunt vs penetrating trauma. RESULTS In 813 patients with blunt trauma (mean [SD] age, 47 [19] years) and 324 patients with penetrating trauma (mean [SD] age, 35 [15] years), the rate of VTE was 9.1% overall (104 of 1137) and similar between groups (blunt trauma, 9% [n = 73] vs penetrating trauma, 9.6% [n = 31]; P = .76). In the blunt trauma group, more patients with VTE than without VTE had abnormal coagulation results (49.3%vs 35.7%; P = .02), femoral catheters (9.6%vs 3.9%; P = .03), repair and/or ligation of vascular injury (15.1%vs 5.4%; P = .001), complex leg fractures (34.2%vs 18.5%; P = .001), Glasgow Coma Scale score less than 8 (31.5%vs 10.7%; P < .001), 4 or more transfusions (51.4%vs 17.6%; P < .001), operation time longer than 2 hours (35.6%vs 16.4%; P < .001), and pelvic fractures (43.8% vs 21.4%; P < .001); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (13 [6] vs 8 [4]; P .001). However, with multivariable analysis, only receiving 4 or more transfusions (odds ratio [OR], 3.47; 95%CI, 2.04-5.91), Glasgow Coma Scale score less than 8 (OR, 2.75; 95%CI, 1.53-4.94), and pelvic fracture (OR, 2.09; 95%CI, 1.23-3.55) predicted VTE, with an area under the receiver operator curve of 0.730. In the penetrating trauma group, more patients with VTE than without VTE had abnormal coagulation results (64.5%vs 44.4%; P = .03), femoral catheters (16.1%vs 5.5%; P = .02), repair and/or ligation of vascular injury (54.8%vs 25.3%; P < .001), 4 or more transfusions (74.2%vs 39.6%; P < .001), operation time longer than 2 hours (74.2%vs 50.5%; P = .01), Abbreviated Injury Score for the abdomen greater than 2 (64.5%vs 42.3%; P = .02), and were aged 40 to 59 years (41.9% vs 23.2%; P = .02); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (12 [4] vs 7 [4]; P < .001). However, with multivariable analysis, only repair and/or ligation of vascular injury (OR, 3.32; 95%CI, 1.37-8.03), Abbreviated Injury Score for the abdomen greater than 2 (OR, 2.77; 95%CI, 1.19-6.45), and age 40 to 59 years (OR, 2.69; 95%CI, 1.19-6.08) predicted VTE, with an area under the receiver operator curve of 0.760. CONCLUSIONS AND RELEVANCE Although rates of VTE are the same in patients who experienced blunt and penetrating trauma, the independent risk factors for VTE are different based on mechanism of injury. This finding should be a consideration when contemplating prophylactic treatment protocols.

UR - http://www.scopus.com/inward/record.url?scp=85012873014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012873014&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2016.3116

DO - 10.1001/jamasurg.2016.3116

M3 - Article

C2 - 27682749

AN - SCOPUS:85012873014

VL - 152

SP - 35

EP - 40

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 1

ER -