Division of Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
Clin Imaging. 2022 Nov;91:134-140. doi: 10.1016/j.clinimag.2022.08.003. Epub 2022 Aug 5.
To determine relationships between prophylactic inferior vena cava filter (IVCF) insertion and pulmonary embolism (PE), deep venous thrombosis (DVT), and in-hospital mortality outcomes in patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries.
Adult patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries admitted to level I-IV trauma centers were selected from the National Trauma Data Bank (NTDB). IVCFs that were inserted both ≤48 h after admission and before a lower extremity venous ultrasound were defined as prophylactic. Associations between prophylactic IVCF insertion and PE, DVT, and overall mortality outcomes during admission were estimated using logistic regression models after propensity score matching. Additionally, factors predictive of prophylactic IVCF insertion were estimated using multivariate logistic regression.
Of 462,838 patients, 11,938 (2.6%) underwent prophylactic IVCF insertion. Prophylactic IVCF utilization decreased over time (6.3% in 2008 to 1.8% in 2015). Factors associated with prophylactic IVCF placement were injury pattern, trauma center level/region, Injury Severity Score, and race. Prophylactic IVCF placement was positively associated with PE (Odds Ratio (OR): 5.25, p < 0.01) and DVT (OR: 5.55, p < 0.01), but negatively associated with in-hospital mortality compared to the propensity score-matched control group (OR: 0.46, p < 0.01).
Prophylactic IVCF insertion in adult patients with severe pelvic/lower extremity fractures, intracranial injuries, and spinal cord injuries was negatively associated with in-hospital mortality, but positively associated with VTE. Further research evaluating the use of prophylactic IVCF placement in trauma patients with these specific severe injury types may be warranted.
确定在严重创伤性骨盆/下肢、颅内和脊髓损伤患者中，预防性下腔静脉滤器（IVCF）置入与肺栓塞（PE）、深静脉血栓形成（DVT）和住院死亡率之间的关系。
从国家创伤数据库（NTDB）中选择了入住 I-IV 级创伤中心的严重创伤性骨盆/下肢、颅内和脊髓损伤的成年患者。在下肢静脉超声检查之前且在入院后 48 小时内插入的 IVCF 被定义为预防性。使用倾向评分匹配后的逻辑回归模型估计预防性 IVCF 插入与入院期间 PE、DVT 和总体死亡率结局之间的关联。此外，还使用多变量逻辑回归估计了预防性 IVCF 插入的预测因素。
在 462838 名患者中，有 11938 名（2.6%）接受了预防性 IVCF 插入。预防性 IVCF 的使用率随时间推移而降低（2008 年为 6.3%，2015 年为 1.8%）。与预防性 IVCF 放置相关的因素包括损伤模式、创伤中心级别/地区、损伤严重程度评分和种族。与匹配后的倾向性评分对照组相比，预防性 IVCF 放置与 PE（优势比（OR）：5.25，p<0.01）和 DVT（OR：5.55，p<0.01）呈正相关，但与住院死亡率呈负相关（OR：0.46，p<0.01）。
在严重骨盆/下肢骨折、颅内损伤和脊髓损伤的成年患者中，预防性 IVCF 插入与住院死亡率呈负相关，但与 VTE 呈正相关。进一步研究评估在这些特定严重损伤类型的创伤患者中预防性 IVCF 放置的使用可能是必要的。
