Abstract
AimVenous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.MethodsWe examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.ResultsThe study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL.ConclusionsAt least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.
Highlights
V ENOUS THROMBOEMBOLISM (VTE), which consists of deep venous thrombosis (DVT) and pulmonary embolism, is a common complication after major trauma associated with increased mortality and morbidity.[1,2]
D-dimer is useful in excluding DVT without the need for further diagnostic imaging, its predictability for VTE in major trauma has not been well established.[11]
Our results suggested that D-dimer levels at 10 days following admission could be a useful predictor of VTE
Summary
White et al and Zakai et al showed that African-Americans had a significantly higher incidence of VTE compared to Asian-Pacific Islanders.[8,9] Wong et al.[10] showed that the incidence of symptomatic VTE in the Asian trauma population was no less than that in Europe and North America. The epidemiology of VTE in major trauma cases among the Japanese population are poorly documented. D-dimer is useful in excluding DVT without the need for further diagnostic imaging, its predictability for VTE in major trauma has not been well established.[11]
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