Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism
Background Disparate lower-extremity ultrasonography (LUS) screening practices among trauma institutions reflecta lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not associated with a redu...
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| Veröffentlicht in: | Surgery 2015-08, Vol.158 (2), p.379-385 |
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| creator | Dietch, Zachary C., MD, MBA Edwards, Brandy L., MD, MSc Thames, Matthew, BA Shah, Puja M., MD Williams, Michael D., MD, FACS Sawyer, Robert G., MD, FACS |
| description | Background Disparate lower-extremity ultrasonography (LUS) screening practices among trauma institutions reflecta lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not associated with a reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high-screening facilities and remaining institutions were designated low-screening facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were reported more commonly in designated high-screening than low-screening facilities (DVT: 1.12% vs 0.72%, P |
| doi_str_mv | 10.1016/j.surg.2015.03.052 |
| format | Article |
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We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not associated with a reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high-screening facilities and remaining institutions were designated low-screening facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were reported more commonly in designated high-screening than low-screening facilities (DVT: 1.12% vs 0.72%, P < .0001; PE: 0.40% vs 0.33%, P = .0004). Multivariable logistic regression demonstrated that LUS was associated independently with DVT (odds ratio 1.43, confidence interval 1.34–1.53) but not PE (odds ratio 1.01, confidence interval 0.92–1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. Conclusion LUS in trauma patients is not associated with a change in the incidence of PE. Aggressive LUS DVT screening protocols appear to detect many clinically insignificant DVTs for which subsequent therapeutic intervention may be unnecessary, and the use of these protocols should be questioned.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2015.03.052</identifier><identifier>PMID: 26032827</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Databases, Factual ; Female ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pulmonary Embolism - epidemiology ; Pulmonary Embolism - etiology ; Pulmonary Embolism - prevention & control ; Retrospective Studies ; Risk Factors ; Surgery ; Trauma Centers - statistics & numerical data ; Ultrasonography ; United States ; Venous Thrombosis - complications ; Venous Thrombosis - diagnostic imaging ; Wounds and Injuries - complications</subject><ispartof>Surgery, 2015-08, Vol.158 (2), p.379-385</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c488t-5b096620d78d3ce46fca21b4de2edeecfb6a4fa7a8dbc53c6998ecf30e89501f3</citedby><cites>FETCH-LOGICAL-c488t-5b096620d78d3ce46fca21b4de2edeecfb6a4fa7a8dbc53c6998ecf30e89501f3</cites><orcidid>0000-0001-8261-1902</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606015003141$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26032827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dietch, Zachary C., MD, MBA</creatorcontrib><creatorcontrib>Edwards, Brandy L., MD, MSc</creatorcontrib><creatorcontrib>Thames, Matthew, BA</creatorcontrib><creatorcontrib>Shah, Puja M., MD</creatorcontrib><creatorcontrib>Williams, Michael D., MD, FACS</creatorcontrib><creatorcontrib>Sawyer, Robert G., MD, FACS</creatorcontrib><title>Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Disparate lower-extremity ultrasonography (LUS) screening practices among trauma institutions reflecta lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not associated with a reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high-screening facilities and remaining institutions were designated low-screening facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were reported more commonly in designated high-screening than low-screening facilities (DVT: 1.12% vs 0.72%, P < .0001; PE: 0.40% vs 0.33%, P = .0004). Multivariable logistic regression demonstrated that LUS was associated independently with DVT (odds ratio 1.43, confidence interval 1.34–1.53) but not PE (odds ratio 1.01, confidence interval 0.92–1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. Conclusion LUS in trauma patients is not associated with a change in the incidence of PE. Aggressive LUS DVT screening protocols appear to detect many clinically insignificant DVTs for which subsequent therapeutic intervention may be unnecessary, and the use of these protocols should be questioned.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Pulmonary Embolism - epidemiology</subject><subject>Pulmonary Embolism - etiology</subject><subject>Pulmonary Embolism - prevention & control</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Trauma Centers - statistics & numerical data</subject><subject>Ultrasonography</subject><subject>United States</subject><subject>Venous Thrombosis - complications</subject><subject>Venous Thrombosis - diagnostic imaging</subject><subject>Wounds and Injuries - complications</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk1v1DAUtBCIbhf-AAfkI5eEZztxEgkhoaotSJUq8XG2HOel6yWJg-207C_gb9fRLhw49GJbzzPj55lHyBsGOQMm3-_zsPi7nAMrcxA5lPwZ2bBS8KwSkj0nGwDRZBIknJHzEPYA0BSsfknOuATBa15tyJ-vOiJ1PR3cA_oMf0ePo40HugzR6-Amd-f1vDtQO9FUWEZNZx0tTjFQG6gOwRmbJDr6YOOO-pNahzjTe5zcEmjceTe2LiR4u0Q6uUjnZRjdpP2BYroZbBhfkRe9HgK-Pu1b8uPq8vvF5-zm9vrLxaebzBR1HbOyhUZKDl1Vd8JgIXujOWuLDjmmN03fSl30utJ115pSGNk0daoKwLopgfViS94ddWfvfi0YohptMDgMesLUrGKyEZVgVVq2hB-hxrsQPPZq9nZMTSsGag1A7dUagFoDUCBUCiCR3p70l3bE7h_lr-MJ8OEIwPTLe4teBZPsNNhZjyaqztmn9T_-RzeDnazRw088YNi7xU_JP8VU4ArUt3UE1glgZTqxgolHBDWw1g</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Dietch, Zachary C., MD, MBA</creator><creator>Edwards, Brandy L., MD, MSc</creator><creator>Thames, Matthew, BA</creator><creator>Shah, Puja M., MD</creator><creator>Williams, Michael D., MD, FACS</creator><creator>Sawyer, Robert G., MD, FACS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8261-1902</orcidid></search><sort><creationdate>20150801</creationdate><title>Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism</title><author>Dietch, Zachary C., MD, MBA ; Edwards, Brandy L., MD, MSc ; Thames, Matthew, BA ; Shah, Puja M., MD ; Williams, Michael D., MD, FACS ; Sawyer, Robert G., MD, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c488t-5b096620d78d3ce46fca21b4de2edeecfb6a4fa7a8dbc53c6998ecf30e89501f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Pulmonary Embolism - epidemiology</topic><topic>Pulmonary Embolism - etiology</topic><topic>Pulmonary Embolism - prevention & control</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Trauma Centers - statistics & numerical data</topic><topic>Ultrasonography</topic><topic>United States</topic><topic>Venous Thrombosis - complications</topic><topic>Venous Thrombosis - diagnostic imaging</topic><topic>Wounds and Injuries - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dietch, Zachary C., MD, MBA</creatorcontrib><creatorcontrib>Edwards, Brandy L., MD, MSc</creatorcontrib><creatorcontrib>Thames, Matthew, BA</creatorcontrib><creatorcontrib>Shah, Puja M., MD</creatorcontrib><creatorcontrib>Williams, Michael D., MD, FACS</creatorcontrib><creatorcontrib>Sawyer, Robert G., MD, FACS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dietch, Zachary C., MD, MBA</au><au>Edwards, Brandy L., MD, MSc</au><au>Thames, Matthew, BA</au><au>Shah, Puja M., MD</au><au>Williams, Michael D., MD, FACS</au><au>Sawyer, Robert G., MD, FACS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>158</volume><issue>2</issue><spage>379</spage><epage>385</epage><pages>379-385</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Disparate lower-extremity ultrasonography (LUS) screening practices among trauma institutions reflecta lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for deep-vein thrombosis (DVT) is not associated with a reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high-screening facilities and remaining institutions were designated low-screening facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were reported more commonly in designated high-screening than low-screening facilities (DVT: 1.12% vs 0.72%, P < .0001; PE: 0.40% vs 0.33%, P = .0004). Multivariable logistic regression demonstrated that LUS was associated independently with DVT (odds ratio 1.43, confidence interval 1.34–1.53) but not PE (odds ratio 1.01, confidence interval 0.92–1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. Conclusion LUS in trauma patients is not associated with a change in the incidence of PE. Aggressive LUS DVT screening protocols appear to detect many clinically insignificant DVTs for which subsequent therapeutic intervention may be unnecessary, and the use of these protocols should be questioned.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26032827</pmid><doi>10.1016/j.surg.2015.03.052</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8261-1902</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Databases, Factual Female Humans Incidence Logistic Models Male Middle Aged Odds Ratio Pulmonary Embolism - epidemiology Pulmonary Embolism - etiology Pulmonary Embolism - prevention & control Retrospective Studies Risk Factors Surgery Trauma Centers - statistics & numerical data Ultrasonography United States Venous Thrombosis - complications Venous Thrombosis - diagnostic imaging Wounds and Injuries - complications |
| title | Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism |
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