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Intramedulläre Stabilisierung beidseitiger Femurfrakturen bei Polytrauma mit primärer Lungenembolie. Chirurg 2009; 80:969-73. [DOI: 10.1007/s00104-009-1753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stawicki SP, Grossman MD, Cipolla J, Hoff WS, Hoey BA, Wainwright G, Reed JF. Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem? Am Surg 2005. [DOI: 10.1177/000313480507100504] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.
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Affiliation(s)
- Stanislaw P. Stawicki
- Department of Surgery, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania
| | - Michael D. Grossman
- Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania
| | - James Cipolla
- Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania
| | - William S. Hoff
- Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania
| | - Brian A. Hoey
- Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania
| | - Gail Wainwright
- Division of Trauma and Critical Care and University of Pennsylvania Trauma Network, Philadelphia, Pennsylvania
| | - James F. Reed
- Research Institute, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania
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