Katsura Morihiro, Fukuma Shingo, Miyata Shin, Ikenoue Tatsuyoshi, Daggupati Sindhu, Martin Matthew J, Inaba Kenji, Matsushima Kazuhide
From the Division of Acute Care Surgery, Department of Surgery (M.K., S.D., M.J.M., K.I., K.M.), Los Angeles General Medical Center, University of Southern California, Los Angeles, California; Human Health Sciences (M.K., S.F.), Kyoto University Graduate School of Medicine, Kyoto; Department of Epidemiology Infectious Disease Control and Prevention (S.F.), Hiroshima University Graduate school of Biomedical and Health Sciences, Hiroshima, Japan; SSM Cardinal Glennon Children's Hospital (S.M.), St. Louis University School of Medicine, Saint Louis, Missouri; and Data Science and AI Innovation Research Promotion Center (T.I.), Shiga University, Shiga, Japan.
J Trauma Acute Care Surg. 2025 Sep 1;99(3):373-381. doi: 10.1097/TA.0000000000004586. Epub 2025 Mar 10.
While severe traumatic brain injury (TBI) faces an increased risk of venous thromboembolism (VTE), pharmacological VTE prophylaxis might be significantly delayed because of concerns for TBI progression. We aimed to assess practice variations in the rate and timing of VTE prophylaxis for adolescent patients with severe TBI between different trauma center types.
This retrospective cohort study using the American College of Surgeon Trauma Quality Improvement Program database (2017-2021) included patients aged 14 to 18 years with severe TBI. Trauma centers were classified as follows: adult trauma center (ATC), mixed trauma center (MTC), and pediatric trauma center (PTC). We developed a multilevel mixed-effect Poisson regression model to assess the association between trauma center type and the rate and timing of VTE prophylaxis. Effect sizes for fixed effects were reported as adjusted incidence rate ratio (aIRR) with 95% confidence interval (CI). Secondary outcomes included the incidence of VTE and late neurosurgical interventions (>72 hours).
Of 7,238 eligible patients, pharmacological VTE prophylaxis was performed in 63.1% at ATC, 59.0% at MTC, and 28.5% at PTC. The median time to the initial prophylaxis was 4 days at ATC, 4 days at MTC, and 6 days at PTC ( p < 0.001). In the regression model, treatment at MTC and PTC was associated with decreased likelihood of VTE prophylaxis (aIRR, 0.89 [95% CI, 0.80-0.97] and aIRR, 0.39 [95% CI, 0.32-0.47]) compared with ATC. Treatment at PTC was associated with higher odds of VTE events (odds ratio, 2.04; 95% CI, 1.16-3.60), while there was no significant difference in the rate of late neurosurgical interventions between ATC and PTC (odds ratio, 1.18; 95% CI, 0.68-2.05).
We observed significant practice variations in the use of pharmacological VTE prophylaxis for adolescent patients with severe TBI between ATC, MTC, and PTC. Further research is warranted to investigate potential drivers of these variations and develop standardized protocols.
Therapeutic/Care management; Level III.
虽然重度创伤性脑损伤（TBI）患者发生静脉血栓栓塞（VTE）的风险增加，但由于担心TBI病情进展，药物性VTE预防可能会显著延迟。我们旨在评估不同类型创伤中心对重度TBI青少年患者进行VTE预防的比率和时机的实践差异。
这项回顾性队列研究使用了美国外科医师学会创伤质量改进项目数据库（2017 - 2021年），纳入了14至18岁的重度TBI患者。创伤中心分类如下：成人创伤中心（ATC）、混合创伤中心（MTC）和儿科创伤中心（PTC）。我们建立了一个多层次混合效应泊松回归模型，以评估创伤中心类型与VTE预防的比率和时机之间的关联。固定效应的效应大小以调整发病率比（aIRR）及95%置信区间（CI）报告。次要结局包括VTE的发生率和晚期神经外科干预（>72小时）。
在7238例符合条件的患者中，ATC进行药物性VTE预防的比例为63.1%，MTC为59.0%，PTC为28.5%。首次预防的中位时间在ATC为4天，MTC为4天，PTC为6天（p < 0.001）。在回归模型中，与ATC相比，在MTC和PTC接受治疗的患者进行VTE预防的可能性降低（aIRR分别为0.89 [95% CI，0.80 - 0.97]和aIRR为0.39 [95% CI，0.32 - 0.47]）。在PTC接受治疗的患者发生VTE事件的几率更高（优势比为2.04；95% CI，1.16 - 3.60），而ATC和PTC之间晚期神经外科干预的发生率没有显著差异（优势比为1.18；95% CI，0.68 - 2.05）。
我们观察到ATC、MTC和PTC在对重度TBI青少年患者使用药物性VTE预防方面存在显著的实践差异。有必要进一步研究以调查这些差异的潜在驱动因素并制定标准化方案。
治疗/护理管理；三级。
