Does preperitoneal packing increase venous thromboembolim risk among trauma patients? A prospective multicenter analysis across 17 level I trauma centers.

J Trauma Acute Care Surg

From the Section of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (L.M.K.), Stanford University School of Medicine; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE) (L.M.K.), Stanford, California; Department of Surgery (A.S., E.E.M.), University of Colorado Denver, Aurora; Ernest E Moore Shock Trauma Center (A.S., E.E.M.), Denver Health, Denver, Colorado; and Department of Surgery (M.M.K.), University of California San Francisco, San Francisco, California.

Published: November 2024

Introduction: Pelvic fractures are associated with a high risk of venous thromboembolism (VTE). Among treatment options, including pelvic angioembolization (PA), preperitoneal pelvic packing (PPP), and pelvic open reduction internal fixation (ORIF), PPP has been postulated as a VTE risk factor. We aimed to characterize the risk of VTE among pelvic fracture patients receiving PPP, PA or ORIF.

Methods: We used observational data from a 17-site Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group, a US level I trauma center collaborative working to identify factors associated with posttraumatic VTE, deep venous thrombosis, pulmonary embolism, or pulmonary thrombosis. The CLOTT criteria included age 18 to 40 years with at least one independent VTE risk factor. We compared outcomes of PPP, PA, and pelvic ORIF to reference of no pelvic intervention. Our primary outcome was VTE. A competing risk analysis was performed.

Results: Among 1,387 pelvic fracture patients, VTE incidence was 5.6%. The ORIF patients were most likely to develop VTE (24.7%), while VTE incidence for PPP was 9.0% and 2.6% for PA. After multivariate, risk-competing analysis, none of the three treatment interventions for pelvic fractures were significantly associated with VTE. Initiation of VTE prophylaxis in the first 24 hours of admission independently halved VTE incidence (hazard ratio, 0.55; confidence interval, 0.33-0.91).

Conclusion: Pelvic fracture interventions do not appear to be independent risk factors for VTE in our study. Initiation of VTE pharmacoprophylaxis within the first 24 hours of admission remains critical to significantly decreasing VTE formation in this high-risk population.

Level Of Evidence: Therapeutic Study; Level III.

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000004416DOI Listing

Publication Analysis

Top Keywords

vte
15
pelvic fracture
12
vte incidence
12
pelvic
10
level trauma
8
pelvic fractures
8
fractures associated
8
ppp pelvic
8
vte risk
8
risk factor
8

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!