Deep vein thrombosis and pulmonary embolus in patients with traumatic brain injury: a prospective observational study.
Praeger AJ., Westbrook AJ., Nichol AD., Wijemunige R., Davies AR., Lyon SM., Wills JL., Bailey M., Rosenfeld JV., Cooper DJ.
BACKGROUND: Intensive care patients with traumatic brain injury (TBI) are at high risk of developing deep vein thrombosis (DVT). A high rate of DVT was reported before routine thromboprophylaxis, but the current DVT rate in TBI patients receiving best-practice mechanical and pharmacological prophylaxis is unknown. OBJECTIVES: To determine the prevalence of DVT among TBI patients. DESIGN, PARTICIPANTS AND SETTING: A prospective observational pilot study of adult patients admitted to the intensive care unit of a level 1 trauma centre within 72 hours of sustaining a TBI (Glasgow Coma Scale score _14). MAIN OUTCOME MEASURES: Rate of DVT determined using twice-weekly compression ultrasound; rate of pulmonary embolism (PE) and length of stay. RESULTS: 36 patients (28 men; mean age, 40.3 years) were included. Six had moderate and 21 had severe TBI. Two patients (6%) developed a DVT and two patients (6%) developed a PE. The proximal leg DVT rate was 3%, but the overall venous thromboembolism rate was 11% (4 patients). CONCLUSIONS: Mechanical and pharmacological prophylaxis appeared to be effective. The incidence of clinically identified PE is of concern and suggests that thromboembolic sources other than large leg veins may not be being adequately controlled by modern thromboprophylaxis regimens.