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Not all deep vein thrombosis is created equal

Incidence of preexisting chronic deep vein thrombosis among high-risk traumatized patients

Tefft, Amy, MD; Moss, Tovah, MD; Stanley, Andrew, MD; Malhotra, Ajai K., MD

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 871–873
doi: 10.1097/TA.0000000000002228
ORIGINAL ARTICLES
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BACKGROUND Traumatized patients are at risk of developing deep vein thrombosis (DVT) and DVT prophylaxis is the standard of care. The Centers for Medicare and Medicaid Services classifies DVT as a hospital-acquired condition and can deny payment for treatment of DVT and, in addition, place financial penalties on hospitals with higher than acceptable rates of DVT, unless the DVT was preexisting. We sought to determine the rate of preexisting chronic DVT among symptomatic traumatized inpatients at our ACS-verified Level 1 trauma center.

METHODS Retrospective review of all traumatized patients admitted for >48 hours over a 7-year study period ending December 2016. Patients who had undergone lower extremity duplex ultrasound (LEDUS) were reviewed further to evaluate the results of these tests. Patients were classified as having either no DVT, acute DVT, or chronic (preexisting) DVT based on sonographic characteristics. Incidence, patient demographics, injury severity and outcomes were compared for patients with and without DVT and also for patients with acute and chronic DVT.

RESULTS Five thousand five hundred forty-three patients met inclusion criteria. Of those, 391 (7.0%) had undergone at least one LEDUS for suspicion of DVT. Deep vein thrombosis was diagnosed in 64 (16%) of the patients undergoing LEDUS and thus 1.1% of the entire population had symptomatic DVT diagnosed during admission. Of the 64 patients with DVT, sonographic characteristics classified 56 (87.5%) as “acute.” 6 (9%) as “chronic” (preexisting) and 2 (3.5%) as “indeterminate.” Among the six patients found to have a preexisting DVT only three (50%) acknowledged a history of DVT.

CONCLUSION In the absence of routine DVT surveillance almost 10% of traumatized patients diagnosed with DVT likely have chronic preexisting DVT that is unknown to the patient in 50% of cases. This has significant financial implications for hospitals.

LEVEL OF EVIDENCE Epidemiologic/Prognostic, level III.

From the Division of Acute Care Surgery, Department of Surgery, University of Vermont Medical Center (A.T., T.M., A.S., A.K.M.), Burlington, Vermont.

Submitted: February 15, 2018, Revised: July 22, 2018, Accepted: July 27, 2018, Published online: February 14, 2019.

Address for reprints: Ajai K Malhotra, MD, 111 Colchester Ave, Burlington, VT 05401; email: Ajai.Malhotra@uvmhealth.org.

© 2019 Lippincott Williams & Wilkins, Inc.