Trauma centers vary in screening for deep vein thrombosis
Research Activities, May 2012, No. 381
After they are admitted to the hospital, trauma patients are at risk for developing blood clots in their leg veins, known as deep vein thrombosis (DVT). In fact, DVT is one of the most common in-hospital complications. As a result, several national agencies have suggested that hospital DVT rates be used as a quality-of-care measurement. In fact, the Centers for Medicare & Medicaid Services no longer reimburses hospitals for DVT after hip and knee joint replacement surgery, deeming it a "reasonably preventable" event. Routine duplex ultrasound screening for DVT has been proposed, although no standards have been established. A recent study looked at screening practices in trauma centers and the opinions of trauma surgeons. It found wide differences in opinions and practices, and concluded that DVT rates alone are not reflective of the true quality of trauma care.
For this study, 317 trauma surgeons received Web-based surveys asking them about their clinical practice regarding DVT screening in asymptomatic trauma patients. In addition, 213 hospitals completed surveys about their policies and procedures on screening. Physicians were asked which patients should be screened, when screening should start, and how often it should be performed. Hospitals were asked about their written guidelines on screening, including the timing and frequency of screening. Among the trauma surgeons, more than half (53 percent) agreed that there should be DVT screening of asymptomatic trauma patients. While three-quarters felt that high-risk patients should be screened, there was no consensus about what factors define a high-risk patient.
Another 36 percent disagreed with screening. More than a quarter of the hospitals surveyed (28 percent) had written screening guidelines that stated that screening should start early and be performed frequently, at least weekly. Patients who can benefit the most from screening include those with spinal cord injuries and pelvic fractures. The study was supported in part by the Agency for Healthcare Research and Quality (HS17952).
See "Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: A survey of individual trauma surgeon opinions and current trauma center practices," by Elliott R. Haut, M.D., Eric B. Schneider, Ph.D., Amar Patel, B.A., and others in the Journal of Trauma 70(1), pp. 27-34, 2011.