高危多发伤患者与下腔静脉滤器的应用
The high-risk polytrauma patient and inferior vena cava filter use.
作者信息
Berber Onur, Vasireddy Aswin, Nzeako Obi, Tavakkolizadeh Adel
机构信息
Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom.
Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom.
出版信息
Injury. 2017 Jul;48(7):1400-1404. doi: 10.1016/j.injury.2017.04.038. Epub 2017 Apr 20.
OBJECTIVES
The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines).
DESIGN
The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data.
RESULTS
A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602).
CONCLUSION
The EAST guidelines are useful but may be overestimating the need for filter insertion.
目的
本研究旨在评估下腔静脉滤器置入指南（东部创伤外科学会：实践管理指南）对临床实践的影响。
设计
本研究在一级创伤中心进行，数据来自“创伤审计与研究网络”，并与医院数据交叉对照。
结果
在6年期间共确定了1138例特定的“高危”重大创伤患者。平均年龄为46岁（18 - 102岁），男女比例为3.3:1。平均损伤严重度评分为23.6（4 - 75）。总体深静脉血栓形成（DVT）发生率为2.6%，肺栓塞（PE）发生率为1.8%。42例（3.8%）患者置入了可回收下腔静脉滤器。滤器取出率为23.8%，平均取出时间为68.5天（4 - 107天）。尽管置入了滤器，但仅报告了1例突破性肺栓塞并发症。将东部创伤外科学会（EAST）指南应用于该队列，预计将有279例（24.6%）患者需要置入滤器。观察到的实践与“EAST滤器组”之间的kappa一致性值为0.103（较差）。“EAST滤器组”的肺栓塞发生率为2.2%，“未置入滤器组”为1.6%（p = 0.601，无统计学差异），观察到的优势比为0.814（95%置信区间0.413, 1.602）。
结论
EAST指南有用，但可能高估了滤器置入的必要性。
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