Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
Department of Medicine, Intermountain Medical Center, Murray, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Am J Surg. 2023 Dec;226(6):891-895. doi: 10.1016/j.amjsurg.2023.07.041. Epub 2023 Aug 1.
Management of below-knee DVT (BKDVT) in trauma patients is uncertain. We hypothesized that BKDVT can be managed with observation only.
Secondary analysis on trauma inpatients March 2017-September 2019 with risk assessment profile ≥5. Management of BKDVT included observation with ultrasound. BKDVT was compared to above-knee DVT (AKDVT), and BKDVT with progression to AKDVT/PE compared to no progression.
Of 1988 patients, 136 (6.8%) BKDVT and 23 (1.2%) AKDVT. 7 (6.9%) BKDVT progressed to AKDVT/PE. 6.9% had BKDVT progression, associated with higher ISS (36.7 vs 21.6, p = 0.005), longer prophylaxis delay (121 vs 45 h, p = 0.02) and longer hospital LOS (25.6 vs 7.8, p = 0.01). None experienced post-thrombotic syndrome.
Majority of BKDVT in hospitalized trauma patients did not progress to AKDVT. Observation for progression, rather than treatment, was not associated with increased PE risk or thrombotic sequelae. Observation with serial ultrasound may serve as a practical alternative to anticoagulation in trauma patients with BKDVT.
创伤患者的膝下型深静脉血栓形成（BKDVT）的管理存在不确定性。我们假设仅通过观察即可对 BKDVT 进行管理。
对 2017 年 3 月至 2019 年 9 月期间的住院创伤患者进行二次分析，风险评估评分≥5。BKDVT 的管理包括通过超声观察。将 BKDVT 与膝上型深静脉血栓形成（AKDVT）进行比较，并将 BKDVT 进展为 AKDVT/PE 与无进展情况进行比较。
1988 例患者中，136 例（6.8%）发生 BKDVT，23 例（1.2%）发生 AKDVT。7 例（6.9%）BKDVT 进展为 AKDVT/PE。6.9%的患者发生 BKDVT 进展，与较高的 ISS（36.7 比 21.6，p=0.005）、更长的预防延迟（121 比 45 小时，p=0.02）和更长的住院 LOS（25.6 比 7.8，p=0.01）相关。没有患者出现血栓后综合征。
住院创伤患者中，大多数 BKDVT 并未进展为 AKDVT。观察进展而非治疗与增加的 PE 风险或血栓后遗症无关。在 BKDVT 创伤患者中，连续进行超声检查可能是抗凝治疗的一种实用替代方法。
