Intensivist performed compression ultrasound for early detection of deep venous thrombosis in critically ill trauma patients – Prospective cohort study

Abstract text (incl. references and figure legends)

Background: Venous thrombo-embolism (VTE) is a serious, potentially preventable, complication of trauma. The aim of this study was to assess the value of bedside Compression Ultrasound performed by trauma intensivists (IPCUS) in detecting early deep venous thrombosis (DVT) in the trauma intensive care units. The secondary aim was to assess risk factors for DVT and its complications in trauma patients.

Materials and Method: We enrolled 362 trauma patients (Nov 1, 2021- June 12, 2022) utilizing IPCUS on Days 0,3,7,14,21 and 28 post admission. Hematology studies including ROTEM and D-Dimer were done on the initial three screening days. Scanning was continued until the patients were discharged, ambulated, therapeutically anticoagulated, completed 28 days of hospital stay, or died. Patients who became ambulatory or were discharged prior to 28 days were followed up clinically as outpatient. Patients with positive or equivocal IPCUS had confirmatory Duplex scan. All pulmonary embolisms (PE) were confirmed by computerized tomographic pulmonary angiograms.

Results: The incidence of VTE in our cohort was 4.7% (Only DVT: 1.4%, only PE: 2.5%, concomitant DVT & PE: 0.8%). All IPCUS detected DVT"s were confirmed by Duplex (n=7), All equivocal results on IPCUS were confirmed negative by Duplex (n=7), 1 patient with negative IPCUS proved to have a clot in the Posterior Tibial vein by Duplex. In the 9 patients with PE without DVT, DVT was ruled out by IPCUS in 9 and Duplex in 7 (In two patients Duplex scanning was missed).The median time post admission for diagnosing DVT was 4.5 days (0-17) and for PE was 2.5 days (0-19). Patients who developed VTE had higher Injury Severity Score, admission Lactate, more central venous lines inserted in the first 24 hours, and delay in the initiation of VTE chemo- prophylaxis.

Conclusion: Our interim analysis showed that bedside Intensivist Performed Compression Ultrasound (IPCUS) is a valuable time-effective tool for early detection of DVT.

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