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Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance

BACKGROUND: Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs...

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Autores principales: Andrade, Alonso, Tyroch, Alan H., McLean, Susan F., Smith, Jody, Ramos, Alex
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357875/
https://www.ncbi.nlm.nih.gov/pubmed/28367009
http://dx.doi.org/10.4103/0974-2700.201589
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author Andrade, Alonso
Tyroch, Alan H.
McLean, Susan F.
Smith, Jody
Ramos, Alex
author_facet Andrade, Alonso
Tyroch, Alan H.
McLean, Susan F.
Smith, Jody
Ramos, Alex
author_sort Andrade, Alonso
collection PubMed
description BACKGROUND: Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs) than lower extremity DVTs (LEDVTs), and therefore, all extremities should be evaluated. MATERIALS AND METHODS: A retrospective chart and trauma registry review of Intensive Care Unit trauma patients with upper and LEDVTs detected on surveillance duplex ultrasound from January 2010 to December 2014 was carried out. Variables reviewed were age, gender, injury severity score, injury mechanism, clot location, day of clot detection, presence of central venous pressure catheter, presence of inferior vena cava filter, mechanical ventilation, and fracture. RESULTS: A total of 136 patients had a DVT in a 5-year period: upper - 71 (52.2%), lower - 61 (44.9%), both upper and lower - 4 (2.9%). Overall, 75 (55.2%) patients had a UEDVT. Upper DVT vein: Brachial (62), axillary (26), subclavian (11), and internal jugular (10). Lower DVT vein: femoral (58), popliteal (14), below knee (4), and iliac (2). 10.3% had a PE: UEDVT - 5 (6.7%) and LEDVT - 9 (14.8%) P = 0.159. CONCLUSIONS: The majority of the DVTs in the study were in the upper extremities. For trauma centers that aggressively screen the lower extremities with venous duplex ultrasound, surveillance to include the upper extremities is warranted.
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spelling pubmed-53578752017-04-01 Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance Andrade, Alonso Tyroch, Alan H. McLean, Susan F. Smith, Jody Ramos, Alex J Emerg Trauma Shock Original Article BACKGROUND: Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs) than lower extremity DVTs (LEDVTs), and therefore, all extremities should be evaluated. MATERIALS AND METHODS: A retrospective chart and trauma registry review of Intensive Care Unit trauma patients with upper and LEDVTs detected on surveillance duplex ultrasound from January 2010 to December 2014 was carried out. Variables reviewed were age, gender, injury severity score, injury mechanism, clot location, day of clot detection, presence of central venous pressure catheter, presence of inferior vena cava filter, mechanical ventilation, and fracture. RESULTS: A total of 136 patients had a DVT in a 5-year period: upper - 71 (52.2%), lower - 61 (44.9%), both upper and lower - 4 (2.9%). Overall, 75 (55.2%) patients had a UEDVT. Upper DVT vein: Brachial (62), axillary (26), subclavian (11), and internal jugular (10). Lower DVT vein: femoral (58), popliteal (14), below knee (4), and iliac (2). 10.3% had a PE: UEDVT - 5 (6.7%) and LEDVT - 9 (14.8%) P = 0.159. CONCLUSIONS: The majority of the DVTs in the study were in the upper extremities. For trauma centers that aggressively screen the lower extremities with venous duplex ultrasound, surveillance to include the upper extremities is warranted. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5357875/ /pubmed/28367009 http://dx.doi.org/10.4103/0974-2700.201589 Text en Copyright: © 2017 Journal of Emergencies, Trauma, and Shock http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Andrade, Alonso
Tyroch, Alan H.
McLean, Susan F.
Smith, Jody
Ramos, Alex
Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title_full Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title_fullStr Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title_full_unstemmed Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title_short Trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
title_sort trauma patients warrant upper and lower extremity venous duplex ultrasound surveillance
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357875/
https://www.ncbi.nlm.nih.gov/pubmed/28367009
http://dx.doi.org/10.4103/0974-2700.201589
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