Citation

Berndtson AE, Costantini TW, Smith AM, Kobayashi L, Coimbra R. J. Trauma Acute Care Surg. 2016; 81(3): 493-499.

Affiliation

University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, aberndtson@ucsd.edu University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, tcostantini@ucsd.edu University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, a6smith@ucsd.edu University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, lkobayashi@ucsd.edu University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, rcoimbra@ucsd.edu.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001157

PMID

27280942

Abstract

BACKGROUND: Sex is associated with disparate risk of venous thromboembolism (VTE) in non-trauma patients, with increased risk seen during pregnancy and in women on hormone-containing medications. Sex effects on VTE after trauma are unclear. Some studies have demonstrated no effect while others have instead shown a higher incidence of VTE among men. We hypothesized that male sex would increase risk of VTE across all age groups in trauma patients undergoing standardized duplex screening.

METHODS: All admissions to a Level-1 academic trauma center 2000-2014 were reviewed. We excluded patients for age <18 years, pregnancy, pre-admission anticoagulant use and hospital length of stay (LOS) <72 hours. A strict venous duplex screening protocol was followed. Female patients were sub-categorized into pre- and post-menopausal groups based on age (18-44 vs. ≥ 55 years). Bivariate analysis and logistic regression were used to identify variables correlating with VTE risk.

RESULTS: 8,726 patients met inclusion criteria. The overall VTE rate was 5.3%. Bivariate analysis did not find a difference in VTE risk by sex (5.1% women vs. 5.4% men, p=0.565), or between women and men within age-defined menopausal categories (pre-menopausal women 3.9% vs. men 4.7%, p=0.293; post-menopausal women 5.9% vs. men 7.0%, p=0.22). Logistic regression (see figure) did identify other risk factors for VTE including age ≥ 55 (AOR 2.0), increasing ISS (AOR 1.5 - 2.1), penetrating mechanism of injury (AOR 2.2), lower extremity injury (AOR 1.7), need for mechanical ventilation (AOR 2.1) and increasing hospital length of stay (LOS 7-28 days, AOR 3.8; LOS > 28 days, AOR 9.1).

CONCLUSION: There was no difference in VTE rates based on patient sex, even after controlling for menopausal status. Aggressive VTE screening of over 8,700 patients did identify several other patient populations at increased risk of developing VTE. More intensive VTE prophylaxis may be appropriate in these patients. LEVEL OF EVIDENCE: Level III, Therapeutic/Care Management.

Language: en