Background
Disparate lower-extremity ultrasonography (LUS) screening practices among trauma institutions
reflecta lack of consensus regarding screening indications and whether screening improves
outcomes. We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not
associated with a reduced incidence of pulmonary embolism (PE).
Methods
The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108
patients treated at institutions reporting at least one LUS and at least one DVT.
Institutions performing LUS on more than 2% of admitted patients were designated high-screening
facilities and remaining institutions were designated low-screening facilities. Patient
characteristics and risk factors were used to develop a logistic regression model
to assess the independent associations between LUS and DVT and between LUS and PE.
Results
Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively.
DVT and PE were reported more commonly in designated high-screening than low-screening
facilities (DVT: 1.12% vs 0.72%, P < .0001; PE: 0.40% vs 0.33%, P = .0004). Multivariable logistic regression demonstrated that LUS was associated
independently with DVT (odds ratio 1.43, confidence interval 1.34–1.53) but not PE
(odds ratio 1.01, confidence interval 0.92–1.12) (c-statistic 0.86 and 0.85, respectively).
Sensitivity analyses performed at various rates for designating HS facilities did
not alter the significance of these relationships.
Conclusion
LUS in trauma patients is not associated with a change in the incidence of PE. Aggressive
LUS DVT screening protocols appear to detect many clinically insignificant DVTs for
which subsequent therapeutic intervention may be unnecessary, and the use of these
protocols should be questioned.
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Article info
Publication history
Published online: May 29, 2015
Accepted:
March 18,
2015
Footnotes
This work was supported by National Institutes of Health grants T32 AI078875 and T32 CA163177.
Disclosure: Committee on Trauma, American College of Surgeons. Chicago, IL, October 2013. The content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figure.
Identification
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
