A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

Lloyd Roberts,Joshua F Ihle,Eldho Paul,Tim Leong,Vinodh Bhagyalakshmi Nanjayya,Adam Lawler,Judit Orosz,Deirdre Murphy,Mark Fitzgerald,Harry Gibbs,Tom Rozen,Kyle Brooks

doi:10.1186/s13613-020-00739-8

Abstract

BackgroundMultiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU.MethodsA prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements.ResultsDuring the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81).ConclusionsThere is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

Highlights

Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU)
Seven scans reported by ICU physicians as uncertain for DVT and two repeat scans performed in patients who were already diagnosed to have DVT in their previous scans were excluded
The main risk factor for DVT was the presence of femoral central venous cannula (CVC) which was present in 26 patients (22%)

Summary

Introduction

Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in highrisk trauma patients in ICU. Deep vein thrombosis (DVT) is a common complication in adult trauma patients in ICU [1,2,3]. Due. Roberts et al Ann. Intensive Care (2020) 10:122 to increased risk of bleeding, anticoagulation for DVT prophylaxis may be withheld for an extended period, in patients with traumatic brain, pelvis, or spinal cord injuries. DVT screening is performed using venous Duplex ultrasound (DUS), contrast venography is the gold standard, as it avoids radiation and contrast exposure [8,9,10,11]

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Conclusion