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Determining venous thromboembolic risk assessment for patients with trauma: The Trauma Embolic Scoring System

Rogers, Frederick B. MD, MS; Shackford, Steven R. MD; Horst, Michael A. PhD, MPHS, MS; Miller, Jo Ann BSN, RN, CCRN; Wu, Daniel DO; Bradburn, Eric DO; Rogers, Amelia BA; Krasne, Margaret

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p 511–515
doi: 10.1097/TA.0b013e3182588b54
EAST 2012 POSTER PAPERS
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BACKGROUND This study aimed to determine the relative “weight” of risk factors known to be associated with venous thromboembolism (VTE) for patients with trauma based on injuries and comorbidities.

METHODS A retrospective review of 16,608 consecutive admissions to a trauma center was performed. Patients were separated into those who developed VTE (n = 141) versus those who did not (16,467). Univariate analysis was performed for each risk factor reported in the trauma literature. Risk factors that were shown to be significant (p < 0.05) by univariate analysis underwent multivariate analysis to develop odds ratios for VTE. The Trauma Embolic Scoring System (TESS) was derived from the multivariate coefficients. The resulting TESS was compared with a data set from the National Trauma Data Bank (2002–2006) to determine its ability to predict VTE.

RESULTS The multivariate analysis demonstrated that age, Injury Severity Score, obesity, ventilator use for more than 3 days, and lower-extremity trauma were significant predictors of VTE in our patient population. The TESS was from 0 to 14, with the best prediction for those patients with a score of more than 6 (sensitivity, 81.6%; specificity, 84%). Overall, the model had excellent discrimination in predicting VTE with a receiver operating characteristic curve of 0.89. The VTE rates for TESS in the National Trauma Data Bank data set were similar for all integers except for 3 and 4, in which the VTE rates were significantly higher (3, 0.2% vs. 0.6%; 4, 0.4% vs. 1.0%).

CONCLUSION The TESS provides an objective measure of classifying VTE risk for patients with trauma. The TESS could allow informed decision making regarding prophylaxis strategies in patients with trauma.

LEVEL OF EVIDENCE Prognostic study, level II.

From the Lancaster General Hospital (F.B.R., M.A.H., J.A.M., D.W., E.B., A.R., M.K.), Lancaster, Pennsylvania; and Scripps Mercy Medical Center (S.R.S.), San Diego, California.

Submitted: November 3, 2011; Revised: March 28, 2012; Accepted: March 29, 2012.

This study was presented as a poster at the 25th annual meeting of the Eastern Association for the Surgery of Trauma, January 10–14, 2012, in Lake Buena Vista, Florida.

Address for reprints: Frederick B. Rogers, MD, MS, FACS, Lancaster General Hospital, 555 N Duke St Lancaster, PA 17602; email: frogers2@lghealth.org.

© 2012 Lippincott Williams & Wilkins, Inc.