School of Postgraduate studies, Royal College of Surgeons in Ireland, Ireland; Department of Trauma and Emergency Medicine, Mater Misericordiae University Hospital (MMUH), Eccles street, Dublin 7, Ireland.
Department of Trauma and Emergency Medicine, Mater Misericordiae University Hospital (MMUH), Eccles street, Dublin 7, Ireland.
Injury. 2024 Dec;55(12):111964. doi: 10.1016/j.injury.2024.111964. Epub 2024 Oct 18.
Venous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors.
A comprehensive database search was conducted using EBSCO/MEDLINE, EMBASE, CINAHL, Cochrane and Scopus to identify studies published between 1990 and 2023. Original Studies quantifying the occurrence of and/or evaluating risk factors for VTE, PE and DVT in a defined population were eligible for inclusion. Five reviewers screened, appraised, and extracted data from the selected studies.
A total of 22 studies fulfilled the inclusion criteria. Most studies were conducted in Northern America (72 %), followed by Asia (18 %), and Europe (9 %). Of the 22 studies, 17 were retrospective, 4 were prospective and 1 was the control arm of an RCT. The reported rates in included studies ranged from 0.39 % to 32 % (VTE), 0.59 % to 57.60 % (DVT) and 0.35 % to 24.0 % (PE). Operative procedure was the most consistently reported associated variable for DVT followed by delays to prophylaxis and pelvic injury. Lower extremity injury was the most frequently reported associated variable for PE followed by male sex and increased age. Age was the most frequently reported variable for both DVT and PE.
There exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.
静脉血栓栓塞症（VTE）是严重创伤后常见且在某些情况下危及生命的并发症。由于在该队列中缺乏高质量的 VTE 风险预测和预防证据，因此严重创伤患者接受了不同的 VTE 预防护理。本系统评价的目的是确定主要创伤患者中 VTE 的报告发生率，并确定相关的危险因素。
使用 EBSCO/MEDLINE、EMBASE、CINAHL、Cochrane 和 Scopus 进行全面的数据库检索，以确定 1990 年至 2023 年期间发表的研究。符合纳入标准的原始研究是定量评估特定人群中 VTE、PE 和 DVT 发生情况和/或评估其危险因素的研究。五名评审员筛选、评估并从选定的研究中提取数据。
共有 22 项研究符合纳入标准。大多数研究在美国北部（72%）进行，其次是亚洲（18%）和欧洲（9%）。在 22 项研究中，17 项为回顾性研究，4 项为前瞻性研究，1 项为 RCT 的对照组。纳入研究报告的发生率范围为 0.39%至 32%（VTE）、0.59%至 57.60%（DVT）和 0.35%至 24.0%（PE）。手术操作是 DVT 最一致报告的相关变量，其次是预防措施延迟和骨盆损伤。下肢损伤是 PE 最常报告的相关变量，其次是男性和年龄增加。年龄是 DVT 和 PE 最常报告的变量。
全球主要创伤患者中 VTE 的报告发生率存在显著差异。手术操作、预防措施延迟和骨盆损伤是 DVT 最一致报告的相关变量。下肢损伤紧随其后的是男性和年龄增加，是 PE 最常报告的相关变量。尽管研究表明 DVT 和 PE 的危险因素可能存在差异，但研究特征和结果报告的异质性妨碍了任何有意义的结论。在比较人群时，有必要协调主要创伤患者的 VTE 发生率。
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