Screening for Occult Lower-Extremity Deep Vein Thrombosis on Admission to Acute Inpatient Rehabilitation

Abstract

Introduction and Background: Early detection and treatment of deep venous thrombosis (DVT) can decrease the morbidity of postthrombotic syndrome as well as the mortality and morbidity resulting from pulmonary embolism. Despite this risk, it is not the standard of care to screen patients for DVT on admission to an inpatient rehabilitation facility (IRF). There are few studies examining the prevalence of occult DVT on admission to acute IRF and the effect of this screening. Guidelines for the prophylaxis of hospitalized patients have informed patient's care for years. Recently, however, the patient population in the inpatient rehabilitation hospitals has changed, and new prophylactic medications have been introduced. Given these changes, the study reviewed the frequency of lower-extremity DVT among consecutive patients admitted to a university-based freestanding rehabilitation facility. Materials and Methods: This pilot, prospective observational cross-sectional study was designed to better understand the prevalence of occult DVT among patients admitted to a freestanding IRF and to identify associated clinical factors. All consecutive patients admitted to our university-based IRF between October and December 2017, excluding those with a preexisting DVT diagnosis or the inability to undergo lower-extremity ultrasound, were consented. All patients were assessed with a bilateral duplex ultrasound of the lower extremities within 72 h of admission. Results: Of 98 patients screened, 47 (48.0%) were male and 51 (53.1%) were female, with a mean age of 61.4 (±14.2) years. The most common admission diagnoses were ischemic stroke (23.5%), debility/medical complexity (22.4%), and hemorrhagic stroke (11.2%). One patient was positive for a lower-extremity DVT on admission screening duplex ultrasound, yielding an incidence of 1.02%. Conclusions: Our study suggests that DVT screening by duplex ultrasound for all patients admitted to an acute IRF does not seem clinically warranted.