Abstract
BackgroundDeep Vein Thrombosis (DVT) is a common complication in trauma patients. Venous duplex surveillance is used widely for the diagnosis of DVT, however, there is controversy concerning its appropriate use. The Wells criterion is a clinically validated scoring system in an outpatient setting, but its use in trauma patients has not been studied. This study evaluated the application of the Wells scoring system in trauma population.MethodsWells scores were calculated retrospectively for all patients who were admitted to the trauma service and underwent Venous Duplex Scanning (VDS) at the author’s institution between 2012 and 2013. Correlation of Wells score with DVT and its efficacy in risk stratifying the patients after trauma was analyzed using linear correlation and receiver operating characteristic (ROC) curve. Sensitivity and specificity of Wells score in ruling out or ruling in DVT were calculated in various risk groups.ResultsOf 298 patients evaluated, 18 (6 %) patients were positive for DVT. A linear correlation was present between Wells score and DVT with R2 = 0.88 (p = 0.0016). Median Wells score of patients without DVT was 1 (1–3) compared to a median score of 2 (1–5) in those with DVT (p < 0.0001). In low risk patients (scores <1), Wells scoring was able to rule out the possibility of DVT with a sensitivity of 100 % and NPV of 100 %, while in moderate-high risk patients (scores ≥2), it was able to predict DVT with a specificity of 90 %. Area under ROC curve was 0.859 (p < 0.0001) demonstrating the accuracy of Wells scoring system for DVT risk stratification in post trauma patients.ConclusionsA Wells score of <1 can reliably rule out the possibility of DVT in the trauma patients. Risk of developing DVT correlates linearly with Wells score, establishing it as a valid pretest tool for risk stratification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0078-1) contains supplementary material, which is available to authorized users.
Highlights
Deep Vein Thrombosis (DVT) is a common complication in trauma patients
The cohort consisted of 298 trauma patients, who underwent Venous Duplex Scanning (VDS) for DVT evaluation
There were no significant differences in the injury severity scores (ISS), age or sex between the patients developing DVT vs. those with no DVT
Summary
Deep Vein Thrombosis (DVT) is a common complication in trauma patients. Venous duplex surveillance is used widely for the diagnosis of DVT, there is controversy concerning its appropriate use. Venous thromboembolism (VTE), comprising of deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third leading cause of death in hospitalized trauma patients, with an estimated incidence of 5–20 % with prophylaxis [1,2,3] This wide range in incidence of VTE is attributed to variability in patients’ risk factors, choice of prophylaxis and modalities of screening and detection of VTE [1, 4]. Thromboprophylaxis in trauma patients is complex for many reasons, one of them being the presence of an early coagulopathy present in 25 % of trauma patients at the time of admission [5], which is further complicated by hypo-perfusion, acidosis and resuscitative measures [4, 6] This coagulopathy shifts to a pro-thrombotic state early after traumatic injury necessitating thromboembolism prophylaxis.
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