In this issue of JAMA Surgery, a retrospective review by Karcutskie et al1 funded by the US Navy and Army examines 813 patients with blunt trauma and 324 patients with penetrating trauma to identify different contributors to the risk of venous thromboembolism (VTE) according to type of trauma. Thirty percent of these patients, who were considered at high risk for VTE because they had a Risk Assessment Profile score of 10 or more, underwent weekly surveillance venous duplex ultrasonography of the lower extremities; the remainder had studies performed based on clinical suspicion of VTE. There was an overall 9.1% rate of VTE in both the blunt and penetrating trauma groups. However, transfusion status, pelvic fractures, and neurologic status were independent predictors of VTE in patients with blunt trauma, while vascular injury, severe abdominal injury, and younger age were important predictors of VTE in those with penetrating trauma. The authors propose that an adjusted Risk Assessment Profile that takes these criteria into account may enable a more intelligent screening and prophylaxis approach to patients who have undergone traumatic injury and are at lower risk for VTE.
Ramos CR, Brewster LP. Advances, Pauses, and Future Opportunity for the Prevention of Venous Thromboembolism in the Trauma Population. JAMA Surg. Published online September 28, 2016. doi:10.1001/jamasurg.2016.3124