Unwarranted National Variation in the Use of Prophylactic Inferior Vena Cava Filters After Trauma: An Analysis of the National Trauma Databank

Abstract

The proportion of patients undergoing placement of prophylactic inferior vena cava (IVC) filters after trauma has increased dramatically in the past decade. Guidelines for prophylactic IVC filters vary from never recommended (American College of Chest Physicians/CHEST) to the more liberal Eastern Association for the Surgery of Trauma guidelines that recommend prophylactic IVC filters for patients who have both contraindications to anticoagulation and high-risk injury patterns. We hypothesized that U.S. trauma centers would practice according to Eastern Association for the Surgery of Trauma guidelines and that any variation in practice patterns would be due to variations in the number of high-risk patients treated. The National Trauma Databank (2002-2007) was used to determine center rates of prophylactic IVC filter placement per high-risk patient. Centers were excluded if they did not submit procedure and comorbidity or diagnoses codes. Patients were excluded if they had diagnoses of deep vein thrombosis or pulmonary embolism, were younger than 16 years, or died within 24 hours of presentation. A total of 1,630,385 patients and 22,808 prophylactic IVC filters from 680 centers were eligible for analysis. We identified center rates of 0 to 13 prophylactic IVC filters per 100 patient admissions and 0 to 206 filters per high-risk patient. Center characteristics could not completely explain this variation, although filters were most commonly placed in the Northeast and least frequently placed in the West (p<0.001). U.S. trauma centers demonstrate considerable variation in the use of prophylactic IVC filter placement after trauma, which could not be entirely explained by either patient or center characteristics.