Department of Surgery, Mercer University School of Medicine, Atrium Navicent Health, Macon, GA, USA.
Am Surg. 2023 Aug;89(8):3460-3464. doi: 10.1177/00031348231167411. Epub 2023 Apr 26.
The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) provides a guideline for when to initiate pharmacologic venous thromboembolism (VTE) prophylaxis in traumatic brain injury (TBI) patients. We hypothesized that implementation of the guideline would not result in progression in intracranial hemorrhage.
The TBI TQIP guideline was implemented at a Level I Trauma Center. Patients with a stable Computerized tomography (CT) of the brain were started on chemical prophylaxis per the Modified Berne-Norwood Criteria. CT scans before and after initiation of treatment were retrospectively reviewed by one board-certified radiologist to determine if there was progression of hemorrhage. Patients without a follow-up CT scan were evaluated for progression of bleed/neurologic deterioration by review of physician notes, nursing documentation, and Glasgow coma scale (GCS).
From July 2017 to December 2020, 12,922 patients were admitted to the trauma service. A total of 552 of these patients had TBI and 269 met inclusion criteria. 55 patients had at least one CT of the brain after initiation of prophylaxis. None of these 55 patients had progression of hemorrhage. 214 patients did not have a CT of the brain after prophylaxis. Chart review showed that none of these patients had a clinical decline. Overall, there was no progression of hemorrhage in the 269 patients that met inclusion criteria.
Initiation of the TQIP TBI VTE prophylaxis guideline was found to be safe with no progression of intracranial hemorrhage.
美国外科医师学会（ACS）创伤质量改进计划（TQIP）提供了颅脑损伤（TBI）患者何时开始药物预防静脉血栓栓塞症（VTE）的指南。我们假设该指南的实施不会导致颅内出血加重。
TBI TQIP 指南在一级创伤中心实施。对于脑 CT 稳定的患者，根据改良伯尔尼-诺伍德标准开始进行化学预防。由一位经过董事会认证的放射科医生对治疗前后的 CT 扫描进行回顾性复查，以确定是否有出血加重。对于没有随访 CT 扫描的患者，通过查阅医生的记录、护理记录和格拉斯哥昏迷量表（GCS）评估是否有出血加重/神经功能恶化的情况。
2017 年 7 月至 2020 年 12 月，共有 12922 名患者入住创伤科。其中共有 552 名患者有 TBI，269 名符合纳入标准。55 名患者在开始预防治疗后至少有一次脑 CT。这 55 名患者中没有一例出现出血加重。214 名患者在预防治疗后没有进行脑 CT。病历回顾显示，这些患者均无临床恶化。总的来说，符合纳入标准的 269 名患者中均无出血加重。
TQIP TBI VTE 预防指南的实施是安全的，没有颅内出血加重的情况。
