创伤性椎体骨折后发生的血栓栓塞事件：190192 例患者的分析。
Thromboembolic Events After Traumatic Vertebral Fractures: An Analysis of 190,192 Patients.
机构信息
Hospital for Special Surgery, New York, NY.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
出版信息
Spine (Phila Pa 1976). 2018 Sep 15;43(18):1289-1295. doi: 10.1097/BRS.0000000000002634.
STUDY DESIGN
Retrospective cohort study OBJECTIVE.: To determine the rate of venous thromboembolism event (VTE) and risk factors for their occurrence in patients with vertebral fractures.
SUMMARY OF BACKGROUND DATA
Deep vein thrombosis or pulmonary embolism (VTE) events are a significant source of potentially preventable morbidity and mortality in trauma patients. In patients with traumatic vertebral fractures, a common high-energy injury sometimes resulting in spinal cord injury, there is debate about what factors may be associated with such VTEs.
METHODS
All patients with vertebral fractures in the American College of Surgeons National Trauma Data Bank Research Data Set (NTDB RDS) from years 2011 and 2012 were identified. Multivariate logistic regression was used to determine factors associated with the occurrence of VTE while considering patient factors, injury characteristics, and hospital course.
RESULTS
A total of 190,192 vertebral fractures patients were identified. The overall rate of VTE was 2.5%. In multivariate analysis, longer inpatient length of stay was most associated with increased VTEs with an odds ratio (OR) of up to 96.60 (95% CI: 77.67 - 129.13) for length of stay longer than 28 days (compared to 0 - 3 days). Additional risk factors in order of decreasing odds ratios were older age (OR of up to 1.65 [95% CI: 1.45 - 1.87] for patients age 70 - 79 years [compared to age 18 - 29 years]), complete spinal cord injuries (OR: 1.49 [95% CI: 1.31 - 1.68]), cancer (OR: 1.37 [95% CI: 1.25 - 1.50]), and obesity (OR: 1.32 [95% CI: 1.18 - 1.48]). Multiple associated non-spinal injuries were also associated with increased rates of VTE.
CONCLUSION
While the overall rate of VTE is relatively low after vertebral fractures, longer LOS and other defined factors to lesser extents were predisposing factors. By determining patients at greatest risk, protocols to prevent such adverse outcomes can be developed and optimized.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究
目的
确定椎体骨折患者静脉血栓栓塞事件（VTE）的发生率和发生 VTE 的危险因素。
背景资料概要
深静脉血栓形成或肺栓塞（VTE）事件是创伤患者潜在可预防发病率和死亡率的一个重要来源。在创伤性椎体骨折患者中，常见的高能损伤有时会导致脊髓损伤，对于哪些因素可能与 VTE 相关存在争议。
方法
在美国外科医师学会国家创伤数据库研究数据集（NTDB RDS）中确定了 2011 年和 2012 年所有患有椎体骨折的患者。通过多变量逻辑回归来确定发生 VTE 的相关因素，同时考虑患者因素、损伤特征和住院过程。
结果
共确定了 190192 例椎体骨折患者。VTE 的总体发生率为 2.5%。在多变量分析中，住院时间延长与 VTE 发生率增加最相关，住院时间超过 28 天的比值比（OR）高达 96.60（95%CI：77.67-129.13）（与 0-3 天相比）。按 OR 降低的顺序，其他风险因素分别为年龄较大（70-79 岁患者的 OR 高达 1.65[95%CI：1.45-1.87]）[与 18-29 岁年龄相比]）、完全性脊髓损伤（OR：1.49[95%CI：1.31-1.68]）、癌症（OR：1.37[95%CI：1.25-1.50]）和肥胖（OR：1.32[95%CI：1.18-1.48]）。多发非脊柱相关损伤也与 VTE 发生率增加相关。
结论
虽然椎体骨折后 VTE 的总体发生率相对较低，但住院时间延长和其他定义的因素在较小程度上也是易患因素。通过确定风险最大的患者，可以制定和优化预防此类不良结局的方案。
证据水平
3 级
Zotero 插件