创伤患者出院后发生的静脉血栓栓塞事件。
Venous thromboembolism events in trauma patients after hospital discharge.
作者信息
Dougherty Jacob M, Gerhardinger Laura J, Johnson Patrick L, Regenbogen Scott E, Scott John W, Sangji Naveen F, Jean Raymond A, Hemmila Mark R, Oliphant Bryant W
机构信息
From the Wayne State University School of Medicine (J.M.D.), Detroit; Department of Surgery (L.J.G., P.L.J., S.E.R., N.F.S., R.A.J., M.R.H.) and Center for Healthcare Outcomes and Policy (L.J.G., P.L.J., S.E.R., N.F.S., R.A.J., M.R.H., B.W.O.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (J.W.S.), University of Washington, Seattle, Washington; and Department of Orthopaedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan.
出版信息
J Trauma Acute Care Surg. 2025 May 1;98(5):704-712. doi: 10.1097/TA.0000000000004527. Epub 2025 Feb 17.
BACKGROUND
Venous thromboembolism (VTE) is common after major injury. This elevated VTE risk likely continues beyond hospital discharge, but a lack of postdischarge surveillance limits our understanding of this complication and opportunities for improving outcomes. We aimed to characterize the incidence and risk factors of trauma patients who developed a VTE in the first year after discharge from their index hospital admission.
METHODS
We used data from adult inpatients (18 years or older) from 35 American College of Surgeons - Committee on Trauma-verified Level 1 and Level 2 trauma centers in a statewide trauma quality improvement program from 2018 to 2023. The incidence and timing of a postdischarge VTE were identified from linked longitudinal insurance claims data, and multivariable logistic regression was performed to identify predictors of a postdischarge event.
RESULTS
Of 34,421 trauma registry and claims matched patients identified, 1,487 (4.3%) developed a VTE within the first year after discharge from the trauma center, compared with 280 VTE events (0.8%) diagnosed during the index admission. The incidence of VTE remained elevated well after discharge, with 40% occurring in the first 30 days and 73% within the first 3 months. Multiple patient, injury, and treatment factors were associated with postdischarge VTE risk, including having an operation, a significant spine injury, Black race, and receiving a blood transfusion.
CONCLUSION
The risk of VTE extends well beyond the index hospitalization for trauma patients, as the majority of events occur after discharge. Understanding and improving VTE outcomes in trauma patients will require a longitudinal patient record that captures these complications. Postdischarge VTEs are an underrecognized trauma-related morbidity but are also very treatable through a better understanding of the risk factors and the optimal prophylactic strategy.
LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level IV.
背景
静脉血栓栓塞症（VTE）在重大创伤后很常见。这种VTE风险升高可能在出院后仍持续存在，但缺乏出院后监测限制了我们对这一并发症的了解以及改善结局的机会。我们旨在描述创伤患者在其首次住院出院后的第一年发生VTE的发生率及危险因素。
方法
我们使用了来自美国外科医师学会创伤委员会认证的35家1级和2级创伤中心的成年住院患者（18岁及以上）的数据，这些数据来自2018年至2023年的一项全州创伤质量改进项目。通过关联的纵向保险理赔数据确定出院后VTE的发生率和时间，并进行多变量逻辑回归以确定出院后事件的预测因素。
结果
在34421名创伤登记和理赔匹配患者中，1487名（4.3%）在创伤中心出院后的第一年内发生了VTE，相比之下，在首次住院期间诊断出280例VTE事件（0.8%）。出院后VTE的发生率在出院后很长时间内仍居高不下，40%发生在头30天内，73%发生在头3个月内。多种患者、损伤和治疗因素与出院后VTE风险相关，包括接受手术、严重脊柱损伤、黑人种族以及接受输血。
结论
创伤患者VTE的风险远远超出首次住院期间，因为大多数事件发生在出院后。了解并改善创伤患者的VTE结局将需要一份能够记录这些并发症的纵向患者记录。出院后VTE是一种未得到充分认识的创伤相关发病率，但通过更好地了解危险因素和最佳预防策略也非常可治。
证据级别
预后和流行病学；四级。
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