Evolution of venous thromboembolism risk assessment in trauma and surgical patients

Abstract

Evolution of venous thromboembolism risk assessment in trauma and surgical patients Krishna Akella, Akella Chendrasekhar Department of Surgery, Richmond University Medical Center, Staten Island, NY, USA Introduction: Development of venous thromboembolism (VTE) is a common cause of in-hospital morbidity and mortality. The initial evaluation of VTE risk in hospitalized surgical patients has become the standard of care. In an attempt to ascertain why patients who had received adequate prophylaxis on initial evaluation had subsequently developed VTE, we hypothesized that in the absence of changing levels of care, risk of VTE does increase in the hospitalized surgical patient population. As the treatment paradigms for moderate and high risk patients are equivalent, we also hypothesized that this change resulted in under-treatment with regard to prophylaxis of VTE. Patients and methods: A retrospective data analysis was performed on 96 adult patients admitted to our surgical service. The initial VTE risk assessment and prophylactic guidelines are based on set criteria mandated by our institution. The initial VTE risk and prophylaxis on admission was noted for each patient. The patient was then subsequently re-evaluated during the hospitalization using the same criteria. Additional information obtained included demographic data, prior surgery, hospital-length of stay, prior history of DVT, and whether or not prophylaxis was appropriate initially and on reassessment. A one-way analysis of variance was then performed. Results: Among the 96 enrolled patients, 76 progressed in their VTE risk resulting in change of risk category. Change by one category of risk occurred in 33 patients, two categories occurred in 19 patients, and three categories occurred in 24 patients. In addition to change in risk category, the need for change in prophylaxis was also evaluated in these patients by comparing percentage of patients given appropriate prophylaxis initially and again on re-evaluation. Discussion: We feel that repeated reassessment of VTE risk throughout a hospital stay is indicated. Prophylactic measures based on risk should also be adjusted accordingly. Keywords: venous thromboembolism, risk assessment, re-evaluation