Yeates Eric O, Grigorian Areg, Schubl Sebastian D, Kuza Catherine M, Joe Victor, Lekawa Michael, Borazjani Boris, Nahmias Jeffry
From the *Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California; and.
†Department of Anesthesiology, University of Southern California Medical Center, Los Angeles, California.
Am Surg. 2020 Apr 1;86(4):362-368.
Patients with severe traumatic brain injury (TBI) are at an increased risk of venous thromboembolism (VTE). Because of concerns of worsening intracranial hemorrhage, clinicians are hesitant to start VTE chemoprophylaxis in this population. We hypothesized that ACS Level I trauma centers would be more aggressive with VTE chemoprophylaxis in adults with severe TBI than Level II centers. We also predicted that Level I centers would have a lower risk of VTE. We queried the Trauma Quality Improvement Program (2010-2016) database for patients with Abbreviated Injury Scale scores of 4 and 5 of the head and compared them based on treating the hospital trauma level. Of 204,895 patients with severe TBI, 143,818 (70.2%) were treated at Level I centers and 61,077 (29.8%) at Level II centers. The Level I cohort had a higher rate of VTE chemoprophylaxis use (43.2% 23.3%, < 0.001) and a shorter median time to chemoprophylaxis (61.9 85.9 hours, < 0.001). Although Level I trauma centers started VTE chemoprophylaxis more often and earlier than Level II centers, there was no difference in the risk of VTE ( = 0.414) after controlling for covariates. Future prospective studies are warranted to evaluate the timing, safety, and efficacy of early VTE chemoprophylaxis in severe TBI patients.
重度创伤性脑损伤（TBI）患者发生静脉血栓栓塞（VTE）的风险增加。由于担心颅内出血恶化，临床医生对于在这一人群中启动VTE化学预防措施犹豫不决。我们假设，美国外科医师学会（ACS）一级创伤中心在重度TBI成年患者中进行VTE化学预防时会比二级中心更积极。我们还预测一级中心的VTE风险会更低。我们查询了创伤质量改进计划（2010 - 2016年）数据库中头部简明损伤量表评分为4分和5分的患者，并根据治疗医院的创伤级别对他们进行比较。在204,895例重度TBI患者中，143,818例（70.2%）在一级中心接受治疗，61,077例（29.8%）在二级中心接受治疗。一级队列中VTE化学预防措施的使用率更高（43.2%对23.3%，P<0.001），且化学预防的中位时间更短（61.9小时对85.9小时，P<0.001）。尽管一级创伤中心比二级中心更频繁、更早地启动VTE化学预防措施，但在控制协变量后，VTE风险并无差异（P = 0.414）。有必要开展未来的前瞻性研究，以评估重度TBI患者早期VTE化学预防的时机、安全性和有效性。
