Jones Lloyd M, Chu Quyen D, Samra Navdeep, Hu Bo, Zhang Wayne W, Tan Tze-Woei
Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Ann Vasc Surg. 2018 Jan;46:36-42. doi: 10.1016/j.avsg.2017.08.018. Epub 2017 Sep 7.
The lack of evidence-based guidelines on the use of prophylactic inferior vena cava filters (IVCFs) in patients after trauma has led to variation of its application. We seek to understand the national trend of the use of prophylactic IVCF in trauma population.
A retrospective review of the National Trauma Databank (2002-2014) was performed to identify patients who received an IVCF after trauma. Those without a preexisting venous thromboembolism or discharge diagnosis of VTE were classified as receiving prophylactic IVCF. Multivariable logistic regression analysis was used to examine associations between the use of prophylactic IVCF and risk factors for VTE. P value ≤0.05 was considered statistically significant.
Among the 2,189,994 patients evaluated, 41,155 (2%) received a prophylactic IVCF. The rate of overall IVCF placement (2.9% in 2002-2006 to 1.6% in 2014, P < 0.001) and prophylactic IVCF placement (2.5% in 2002-2006 to 1.2% in 2014, P < 0.001) decreased over the study period. In multivariable analysis, significant risk factors associated with the use of prophylactic IVCF were male gender (OR 1.2, 95% CI 1.1-1.2), African-American race (OR 1.2, 95% CI 1.1-1.2), injury severity score ≥ 24 (OR 4.4, 95% CI 4.2-4.5), Glasgow Coma Scale <8 (OR 1.4, 95% CI 1.4-1.5), spinal cord injury with paraplegia (OR 5.1, 95% CI 4.7-5.6), pelvic fracture (OR 2.9, 95% CI 2.7-3.0), long bone fracture (OR 1.3, 95% CI 1.3-1.4), and solid organ injury (OR 1.2, 95% CI 1.2-1.3) (P < 0.001). Patients who were treated at a level-II trauma center (OR 1.1, 95% CI 1.1-1.2, P < 0.001), at a facility with ≥200 beds (OR 1.3, 95% CI 1.2-1.4, P < 0.001), and those with medical insurance coverage (OR 1.4, 95% CI 1.6-1.8, P < 0.001) were also more likely to receive a prophylactic IVCF.
The utilization of prophylactic IVCF in trauma patients has decreased over time between 2008 and 2014. Considerable variation exists in its use, which is not fully accounted for by the VTE rate. Further study is required to evaluate appropriate indications for placement of prophylactic IVCF in trauma patients.
缺乏关于创伤后患者使用预防性下腔静脉滤器（IVCF）的循证指南，导致其应用存在差异。我们试图了解创伤人群中预防性IVCF使用的全国趋势。
对国家创伤数据库（2002 - 2014年）进行回顾性研究，以确定创伤后接受IVCF的患者。那些既往无静脉血栓栓塞症或出院诊断为VTE的患者被归类为接受预防性IVCF。采用多变量逻辑回归分析来检验预防性IVCF的使用与VTE危险因素之间的关联。P值≤0.05被认为具有统计学意义。
在评估的2189994例患者中，41155例（2%）接受了预防性IVCF。在研究期间，总体IVCF置入率（2002 - 2006年为2.9%至2014年为1.6%，P < 0.001）和预防性IVCF置入率（2002 - 2006年为2.5%至2014年为1.2%，P < 0.001）均下降。在多变量分析中，与预防性IVCF使用相关的显著危险因素包括男性（比值比1.2，95%置信区间1.1 - 1.2）、非裔美国人种族（比值比1.2，95%置信区间1.1 - 1.2）、损伤严重程度评分≥24（比值比4.4，95%置信区间4.2 - 4.5）、格拉斯哥昏迷量表<8（比值比1.4，95%置信区间1.4 - 1.5）、脊髓损伤伴截瘫（比值比5.1，95%置信区间4.7 - 5.6）、骨盆骨折（比值比2.9，95%置信区间2.7 - 3.0）、长骨骨折（比值比1.3，95%置信区间1.3 - 1.4）和实体器官损伤（比值比1.2，95%置信区间1.2 - 1.3）（P < 0.001）。在二级创伤中心接受治疗的患者（比值比1.1，95%置信区间1.1 - 1.2，P < 0.001）、在床位≥200张的机构接受治疗的患者（比值比1.3，95%置信区间1.2 - 1.4，P < 0.001）以及有医疗保险覆盖的患者（比值比1.4，95%置信区间1.6 - 1.8，P < 0.001）也更有可能接受预防性IVCF。
2008年至2014年期间，创伤患者预防性IVCF的使用率随时间下降。其使用存在相当大的差异，VTE发生率并不能完全解释这种差异。需要进一步研究以评估创伤患者预防性IVCF置入的合适指征。
