Abstract
Trauma patients have the highest risk of VTE among hospitalised patients1, with a reported 13-fold increase of risk2. Due to the heterogeneity of injuries, the true incidence of VTE in trauma patients is difficult to obtain. This study examines the incidence of VTE and associated complications in trauma patients with lower limb injuries.
Between 2005 and 2009, patients over 18 years of age with lower limb injuries and/or fractures that were either isolated or a part of multi-systemic injuries were included in the study. Further stratification was performed according to the Injury Severity Score: an ISS greater than 15 was a major (trauma); less than 15, a minor. The mode of VTE prophylaxis, type of surgery, and bleeding complications were also examined.
There were 5528 patients in the minor trauma group, and 509 in the major trauma group. Minor trauma: the mean age was 58.1 years (range: 18 – 104). The VTE incidence was 1.2%: 0.67% for DVT, and 0.5% for PE. The readmission rate within a three-month period was 11%, of which 2.8% were due to VTE with 13 cases of DVT, and 5 cases of PE. The 30-day mortality rate was 2.2%. Seven patients died from PE during admission, while one died from PE within three months after discharge.
Major trauma: the mean age was 42.5 years (range: 18 – 95). The overall VTE incidence was 7.8%: 5.9% for DVT, and 0.9% for PE. The readmission rate within a three-month period was 7.6%, of which 5% were due to VTE with 2 cases of DVT. The overall 30-day mortality rate was 11.1%, and there was no formally-diagnosed fatal PE during admission or post-discharge.
Major trauma patients had a 7-fold increased risk of developing VTE during admission when compared to minor trauma patients, although minor trauma patients had more fatal PEs. Additionally, major trauma patients had a 10-fold increased risk for DVT, and a 3-fold risk for PE, when compared with minor trauma patients. No significant difference was detected between the two groups for the 30-day readmission rate due to VTE.
