创伤后我们还能一直担心静脉血栓栓塞症吗？
Can we ever stop worrying about venous thromboembolism after trauma?
出版信息
J Trauma Acute Care Surg. 2015 Mar;78(3):475-80; discussion 480-1. doi: 10.1097/TA.0000000000000556.
BACKGROUND
Trauma patients are known to be at increased risk for venous thromboembolism (VTE); this risk may change over time following injury. Determining the period in which patients are at increased risk of developing VTE may have an impact on prophylaxis, cost, and quality of care.
METHODS
The California Office of Statewide Health Planning and Development hospital discharge database was searched between 1995 and 2010 for patients admitted with traumatic pelvic fractures, vertebral fractures, and spinal cord injuries. Those patients were then searched for VTE any time after injury. Cox proportional hazards analyses were used to assess the timing and risk of VTE events after injury.
RESULTS
A total of 267,743 trauma patients met the injury criteria; of those, 10,633 or 3.97% developed VTE. The occurrence of VTE was a significant predictor of mortality (hazard ratio [HR], 1.18; p < 0.001). Compared with patients with pelvic fractures, patients with vertebral fractures were less likely to develop VTE (HR, 0.85; p = 0.002). However, patients with spinal cord injury were more likely to develop VTE (HR, 3.17; p < 0.001); this remained true when in combination with a pelvic fracture (HR, 2.17; p = 0.001). Patients with cervical or thoracic spinal cord injuries were significantly more likely to develop VTE (HR of 1.49 [p = 0.037] and 1.87 [p = 0.001], respectively), compared with those with lumbar injury.In the first 3 months after injury, the incidence of VTE is 10.3%. This rate dropped to 0.5% by 6 months after injury, subsequently falling to 0.2% at 1 year and 0.14% at 18 months and remaining low at 0.12% at 2 years.
CONCLUSION
The highest risk of VTE is during the first 3 months after injury; between 12 months and 15 months, the rate returns to that of the general population at 0.1% to 0.2%. These results may guide management strategies such as duration of VTE prophylaxis and removal of inferior vena cava filters, which may have an impact on quality of care.
LEVEL OF EVIDENCE
Epidemiologic study, level IV.
背景
创伤患者发生静脉血栓栓塞症（VTE）的风险增加；这种风险在受伤后可能会随时间变化。确定患者发生 VTE 的风险增加的时间段可能会影响预防、成本和护理质量。
方法
在 1995 年至 2010 年期间，通过加利福尼亚州全州卫生规划和发展办公室的医院出院数据库，搜索因创伤性骨盆骨折、椎体骨折和脊髓损伤而住院的患者。然后，搜索这些患者受伤后任何时间的 VTE 情况。使用 Cox 比例风险分析评估受伤后 VTE 事件的时间和风险。
结果
共有 267743 名符合创伤标准的创伤患者；其中 10633 例（3.97%）发生 VTE。VTE 的发生是死亡的显著预测因素（风险比[HR]，1.18；p < 0.001）。与骨盆骨折患者相比，椎体骨折患者发生 VTE 的可能性较小（HR，0.85；p = 0.002）。然而，脊髓损伤患者发生 VTE 的可能性更高（HR，3.17；p < 0.001）；当与骨盆骨折相结合时也是如此（HR，2.17；p = 0.001）。与颈段或胸段脊髓损伤患者相比，颈段或胸段脊髓损伤患者发生 VTE 的风险显著更高（HR 分别为 1.49 [p = 0.037]和 1.87 [p = 0.001]）。受伤后 3 个月内，VTE 的发生率为 10.3%。这一比率在受伤后 6 个月降至 0.5%，随后在 1 年降至 0.2%，在 18 个月降至 0.14%，在 2 年时仍保持较低水平，为 0.12%。
结论
VTE 的最高风险发生在受伤后的前 3 个月；在 12 至 15 个月之间，该比率恢复到普通人群的 0.1%至 0.2%。这些结果可能指导管理策略，如 VTE 预防的持续时间和下腔静脉滤器的去除，这可能对护理质量产生影响。
证据等级
流行病学研究，IV 级。
Zotero 插件