Venous Thromboembolism in a Single Korean Trauma Center: Incidence, Risk Factors, and Assessing the Validity of VTE Diagnostic Tools
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Trauma increases the risk of venous thromboembolism (VTE) in hospitalized patients. However, the risk and incidenceof VTE in Korean trauma patients are limited. Therefore, we aimed to evaluate the incidence and identify potential predictors ofVTE occurrence in Korean trauma patients. Moreover, we assessed the validity of the Greenfield risk assessment profile (RAP)and the trauma embolic scoring system (TESS) in these patients. Materials and Methods: This retrospective cohort study used the data of trauma patients who were admitted to a regional traumacenter between 2010 and 2016 and were eligible for entry into the Korea Trauma Data Bank. Clinical data were collected from hospitalmedical records. The patient’s baseline characteristics and clinical data were compared between VTE and non-VTE groups. Results: We included 9472 patients. The overall VTE rate was 0.87% (n=82), with 56 (0.59%) events of deep vein thrombosis and 39(0.41%) of pulmonary embolism. Multiple regression analysis revealed that variables, including VTE history, pelvic-bone fracture,ventilator use, and hospitalization period, were significant, potential predictors of VTE occurrence. This study showed that increasedRAP and TESS scores were correlated with increased VTE rate, with rates of 1% and 1.5% for the RAP and TESS scores of 6,respectively. The optimal cut-off value for RAP and TESS scores was 6. Conclusion: RAP and TESS, which are well-known diagnostic tools, demonstrated potentials in predicting the VTE occurrence inKorean trauma patients. Additionally, patients with pelvic-bone fractures and long-term ventilator treatment should be carefullyexamined for possible VTE.
Abstract
Purpose: Trauma increases the risk of venous thromboembolism (VTE) in hospitalized patients. However, the risk and incidenceof VTE in Korean trauma patients are limited. Therefore, we aimed to evaluate the incidence and identify potential predictors ofVTE occurrence in Korean trauma patients. Moreover, we assessed the validity of the Greenfield risk assessment profile (RAP)and the trauma embolic scoring system (TESS) in these patients. Materials and Methods: This retrospective cohort study used the data of trauma patients who were admitted to a regional traumacenter between 2010 and 2016 and were eligible for entry into the Korea Trauma Data Bank. Clinical data were collected from hospitalmedical records. The patient’s baseline characteristics and clinical data were compared between VTE and non-VTE groups. Results: We included 9472 patients. The overall VTE rate was 0.87% (n=82), with 56 (0.59%) events of deep vein thrombosis and 39(0.41%) of pulmonary embolism. Multiple regression analysis revealed that variables, including VTE history, pelvic-bone fracture,ventilator use, and hospitalization period, were significant, potential predictors of VTE occurrence. This study showed that increasedRAP and TESS scores were correlated with increased VTE rate, with rates of 1% and 1.5% for the RAP and TESS scores of 6,respectively. The optimal cut-off value for RAP and TESS scores was 6. Conclusion: RAP and TESS, which are well-known diagnostic tools, demonstrated potentials in predicting the VTE occurrence inKorean trauma patients. Additionally, patients with pelvic-bone fractures and long-term ventilator treatment should be carefullyexamined for possible VTE.
참고문헌 (23)
- Heit JA, "Epidemiology of venous thromboembolism", Nat Rev Cardiol, 12, pp.464~474 (2015)
- Yeo DXW, "Incidence of venous thromboembolism and its pharmacological prophylaxis in Asian general surgery patients : a systematic review", World J Surg, 39, pp.150~157 (2015)
- Nakamura M, "Current management of venous thromboembolism in Japan : current epidemiology and advances in anticoagulant therapy", J Cardiol, 66, pp.451~459 (2015)
- Yhim HY, "Incidence of venous thromboembolism following major surgery in Korea : from the Health Insurance Review and Assessment Service database", J Thromb Haemost, 12, pp.1035~1043 (2014)
- Lee CH, "Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population", J Thromb Haemost, 8, pp.1515~1523 (2010)
- Cheuk BLY, "Epidemiology of venous thromboembolism in a Chinese population", Br J Surg, 91, pp.424~428 (2004)
- Jang MJ, "Incidence of venous thromboembolism in Korea : from the Health Insurance Review and Assessment Service database", J Thromb Haemost, 9, pp.85~91 (2011)
- Rogers FB, "Practice management guidelines for the prevention of venous thromboembolism in trauma patients : the EAST practice management guidelines work group", J Trauma Acute Care Surg, 53, pp.142~164 (2002)
- Chu CC, "Venous thromboembolism associated with lower limb fractures after trauma : dilemma and management", J Orthop Sci, 20, pp.364~372 (2015)
- Geerts WH, "Prevention of venous thromboembolism : American College of Chest Physicians evidence-based clinical practice guidelines", Chest, 133, pp.381~ (2008)
- Knudson MM, "Thromboembolism after trauma : an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank", Ann Surg, 240, pp.490~496 (2004)
- Allen CJ, "Surveillance and early management of deep vein thrombosis decreases rate of pulmonary embolism in high-risk trauma patients", J Am Coll Surg, 222, pp.65~72 (2016)
- Rogers FB, "Determining venous thromboembolic risk assessment for patients with trauma : the Trauma Embolic Scoring System", J Trauma Acute Care Surg, 73, pp.511~515 (2012)
- Greenfield LJ, "Posttrauma thromboembolism prophylaxis", J Trauma Acute Care Surg, 42, pp.100~103 (1997)
- Ho KM, "Use of the Trauma Embolic Scoring System(TESS)to predict symptomatic deep vein thrombosis and fatal and non-fatal pulmonary embolism in severely injured patients", Anaesth Intensive Care, 42, pp.709~714 (2014)
- Meizoso JP, "A simplified stratification system for venous thromboembolism risk in severely injured trauma patients", J Surg Res, 207, pp.138~144 (2017)
- Fischer JE, "A readers’ guide to the interpretation of diagnostic test properties : clinical example of sepsis", Intensive Care Med, 29, pp.1043~1051 (2003)
- Geerts WH, "A prospective study of venous thromboembolism after major trauma", N Engl J Med, 331, pp.1601~1606 (1994)
- Knudson MM, "Thromboembolism following multiple trauma", J Trauma, 32, pp.2~11 (1992)
- Haut ER, "Predictors of posttraumatic deep vein thrombosis(DVT) : hospital practice versus patient factors-an analysis of the National Trauma Data Bank(NTDB)", J Trauma, 66, pp.994~1001 (2009)
- Barrera LM, "Thromboprophylaxis for trauma patients", Cochrane Database Syst Rev, (3), pp.CD008303~ (2013)
- White RH, "Effects of race and ethnicity on the incidence of venous thromboembolism", Thromb Res, 123(Suppl 4), pp.S11~S17 (2009)
- Wong TH, "Symptomatic venous thromboembolism in Asian major trauma patients : incidence, presentation and risk factors", Eur J Trauma Emerg Surg, 39, pp.495~500 (2013)