Venous Thromboembolism in Patients With Blunt Trauma: Are Comprehensive Guidelines the Answer?

Objectives: This study was designed to determine the outcome of implemented guidelines for venous throm­boembolism (VTE) prophylaxis.

Methods: This study was a retrospective review of a series of consecutive blunt orthopaedic trauma patients with thromboembolic complications. The patients were compared to controls over the same 10-year period. Univariate and multivariate statistical methods were used to determine the odds of VTE in the setting of this management guideline and risk factors for throm­boembolic complications that may be refractory to this strategy.

Results: In the 10 years following institution of clinical management guidelines at our institution, the rate of VTE events was 3.2%, and the rate of pulmonary embolus was 0.3%. Risk factors for VTE that were refractory to our clinical management guidelines were pelvic frac­tures, major lower extremity injury, greater than 3 days of mechanical ventilation, increasing injury severity, and spinal cord injury.

Conclusions: The implementation of a clinical man­agement strategy for decreasing the incidence of VTE in blunt trauma patients and other potentially prevent­able complications is essential. Our data suggest that patients with certain injuries are particularly at risk for VTE and warrant special attention in clinical manage­ment and risk stratification, despite effective clinical management guidelines.