Not all DVT is created equal: incidence of pre-existing chronic DVT among high-risk traumatized patients

Background Traumatized patients are at risk of developing Deep Vein Thrombosis (DVT) and DVT prophylaxis is the standard of care. The Centers for Medicare and Medicaid Services classifies DVT as a Hospital Acquired Condition and can deny payment for treatment of DVT and, in addition, place financial penalties on hospitals with higher than acceptable rates of DVT, unless the DVT was pre-existing. We sought to determine the rate of pre-existing chronic DVT among symptomatic traumatized inpatients at our ACS-verified Level 1 trauma center. Methods Retrospective review of all traumatized patients admitted for >48 hours over a 7-year study period ending December 2016. Patients who had undergone Lower Extremity Duplex Ultrasound (LEDUS) were reviewed further to evaluate the results of these tests. Patients were classified as having either no DVT, acute DVT, or chronic (pre-existing) DVT based on sonographic characteristics. Incidence, patient demographics, injury severity and outcomes were compared for patients with and without DVT and also for patients with acute and chronic DVT. Results 5543 patients met inclusion criteria. Of those, 391 (7.0%) had undergone at least one LEDUS for suspicion of DVT. DVT was diagnosed in 64 (16%) of patients undergoing LEDUS and thus 1.1% of the entire population had symptomatic DVT diagnosed during admission. Of the 64 patients with DVT, sonographic characteristics classified 56 (87.5%) as ‘acute’, 6 (9%) as ‘chronic’ (pre-existing) and 2 (3.5%) as ‘indeterminate.’ Among the 6 patients found to have a pre-existing DVT only 3 (50%) acknowledged a history of DVT. Conclusions In the absence of routine DVT surveillance almost 10% of traumatized patients diagnosed with DVT likely have chronic pre-existing DVT that is unknown to the patient in 50% of cases. This has significant financial implications for hospitals. Level of Evidence Level IV, Diagnostic test Correspondence: Ajai K Malhotra, MD FACS 111 Colchester Avenue Burlington VT 05401 Phone: (802) 847 4910 The study did not receive any funding from any source None of the authors have any conflict of interests Presented at 48th annual meeting of Western Trauma Association, 2018, Whistler, BC, Canada © 2019 Lippincott Williams & Wilkins, Inc.

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