Cornwell Edward E, Chang David, Velmahos George, Jindal Anurag, Baker Deborah, Phillips Judy, Bonar James, Campbell Kurtis
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287-5675, USA.
Am Surg. 2002 May;68(5):470-3.
The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). "Full compliance" was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT risk factors were common (83%) and adjunctive heparin prophylaxis was infrequent (27%). The most common times for "noncompliant" observations were early afternoon and midmorning. On multivariate analysis only spinal column injury correlated with increased compliance. In nearly half of the observations trauma patients at risk for DVT were not receiving their SCD prophylaxis as per physician orders. Fewer than 20 per cent of patients had the devices on and functioning during each of the six observations during a 24-hour period. These data point to the need for education of hospital staff and for additional prophylactic measures in at-risk patients.
序贯加压装置（SCD）常常是用于预防创伤患者深静脉血栓形成（DVT）的唯一措施。本研究的目的是评估有DVT风险的非卧床创伤患者对医生下达的SCD预防应用医嘱的依从性。我们在两家一级大学附属医院创伤中心进行了一项前瞻性观察研究。在非重症监护环境下，对非卧床创伤患者入院后的早期阶段进行观察。在24小时内对SCD的正确应用进行6次观察（早班2次、晚班2次、夜间2次）。“完全依从”定义为在所有6次观察中SCD开启且运行正常。在对227例患者的总共1343次观察中，仅有42例患者（19%）完全依从。装置开启且运行的观察有712次（53%）。在185例未完全依从的患者中，DVT危险因素很常见（83%），而辅助性肝素预防措施很少使用（27%）。“不依从”观察最常见的时间是下午早些时候和上午中段时间。多因素分析显示，只有脊柱损伤与依从性增加相关。在近一半的观察中，有DVT风险的创伤患者未按医生医嘱接受SCD预防措施。在24小时内的6次观察中，每次仅有不到20%的患者开启并使用了该装置。这些数据表明需要对医院工作人员进行教育，并对高危患者采取额外的预防措施。
