Prabhakaran Kartik, Gogna Shekhar, Lombardo Gary, Latifi Rifat
Section of Trauma and Acute Care Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Section of Trauma and Acute Care Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
J Surg Res. 2020 Oct;254:327-333. doi: 10.1016/j.jss.2020.05.008. Epub 2020 Jun 7.
Venous thromboembolism (VTE) places elderly trauma patients at a high risk of morbidity. The purpose of this study was to determine the outcomes related to VTE in geriatric trauma patients, as well as to identify risk factors for the development of VTE in this population. We also assessed the impact of the type and timing of VTE prophylaxis, and the type of injuries, on development of VTE in geriatric trauma population.
We performed a 2-year retrospective review from American College of Surgeons-Trauma Quality Improvement Project (ACS-TQIP) databank from 2014 to 2016. A total of 354,272 patients aged 65 y or older who developed VTE after trauma were included in the study.
Overall, 354,272 elderly trauma patients with complete records were identified from the year 2014 to 2016, and of this, 4290 (1.1%) patients developed in-hospital VTE. Male gender was more predominant in the VTE group (P < 0.001). Both the ICU length of stay and hospital length of stay (P < 0.001) were higher in the VTE group. Spine injury (P = 0.002), lower extremity injury (P < 0.001), age category 75-84 y (P < 0.001), age ≥85 y (P < 0.001), frailty (P < 0.001), severe traumatic brain injury (TBI) (GCS3-8) (P < 0.001), ventilator days (P < 0.001), and transfusion of plasma products in first 24 h of admission (P < 0.001) were independent predictors of developing VTE after trauma in the elderly. Higher injury severity score, TBI, and transfusion of packed red blood cells within 24 h were associated with longer time to initiate VTE prophylaxis. Time to initiate chemical deep vein thrombosis prophylaxis was significantly longer in those patients that developed VTE (3.73 ± 4.82 d), when compared with those patients without VTE ((1.81 ± 2.53 d) (P < 0.001).
Our study demonstrates that ICU and hospital length of stay were higher in VTE group. Frailty, severe TBI, spine injury, lower extremity injury, longer duration of mechanical ventilation, and transfusion of plasma products in the first 24 h of hospital admission were independent predictors of developing VTE after trauma in elderly. Type and timing of VTE prophylaxis were not significant independent predictors of developing VTE after trauma, while higher injury severity score, TBI, and transfusion of packed red blood cells within 24 h were associated with longer time to initiate VTE prophylaxis. Future multi-institutional prospective studies are warranted to gather more evidence on this topic.
静脉血栓栓塞症（VTE）使老年创伤患者面临较高的发病风险。本研究的目的是确定老年创伤患者中与VTE相关的结局，并识别该人群发生VTE的危险因素。我们还评估了VTE预防的类型和时机以及损伤类型对老年创伤人群VTE发生的影响。
我们对2014年至2016年美国外科医师学会创伤质量改进项目（ACS-TQIP）数据库进行了为期2年的回顾性研究。共有354272名65岁及以上创伤后发生VTE的患者纳入本研究。
总体而言，2014年至2016年共识别出354272例有完整记录的老年创伤患者，其中4290例（1.1%）患者发生院内VTE。VTE组男性更为多见（P<0.001）。VTE组的重症监护病房住院时间和住院时间均更长（P<0.001）。脊柱损伤（P=0.002）、下肢损伤（P<0.001）、75-84岁年龄组（P<0.001）、≥85岁年龄组（P<0.001）、衰弱（P<0.001）、重度创伤性脑损伤（TBI）（格拉斯哥昏迷评分3-8分）（P<0.001）、机械通气天数（P<0.001）以及入院后24小时内输注血浆制品（P<0.001）是老年创伤后发生VTE的独立预测因素。损伤严重程度评分较高、TBI以及24小时内输注红细胞与开始VTE预防的时间较长有关。发生VTE的患者开始化学性深静脉血栓预防的时间显著长于未发生VTE的患者（3.73±4.82天 vs 1.81±2.53天）（P<0.001）。
我们的研究表明，VTE组的重症监护病房和住院时间更长。衰弱、重度TBI、脊柱损伤、下肢损伤、机械通气时间延长以及入院后24小时内输注血浆制品是老年创伤后发生VTE的独立预测因素。VTE预防的类型和时机不是创伤后发生VTE的显著独立预测因素，而较高的损伤严重程度评分、TBI以及24小时内输注红细胞与开始VTE预防的时间较长有关。未来需要多机构前瞻性研究以收集更多关于该主题的证据。
