No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review.

No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review.

Aziz Hiba Abdel; Hileman Barbara M; Chance Elisha A

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2018

2018-12

PURPOSE: To assess the effect of surveillance on deep vein thrombosis (DVT) and pulmonary embolism (PE) rates, the efficacy of chemoprophylaxis and mechanical prophylaxis, and the relationship between DVT and PE. METHODS: A 23 year, systematic literature review was performed in PubMed. Twenty publications with \textgreater 13,000 patients were reviewed. Analyzed traits included: DVT surveillance utilization, the total number of patients included in each study, the number of patients developing DVT and/or PE, chemoprophylaxis and mechanical prophylaxis utilization. When event proportions from individual studies were combined, a weighted mean proportion was computed based on the size of each individual cohort. Combined event proportions were compared with other combined event proportions, according to differences in intervention. Inter-group event proportions were compared using Chi-Square or Fisher's exact test, as appropriate. RESULTS: DVT rates increase with surveillance (10.7% vs. 2.5%, p \textless 0.001). PE rates were similar regardless of surveillance (p = 1.0). Chemoprophylaxis lowered both DVT rates (8.2% vs. 10.7%; p \textless 0.0001) and PE rates (1.2% vs. 1.9%; p = 0.0050). Mechanical prophylaxis did not decrease DVT rates (10.2% vs. 11.5%; p = 0.2980) or PE rates (1.7% vs. 1.6%; p = 1.0). In patients with neither chemoprophylaxis nor mechanical prophylaxis, DVT rate was 11.5%, PE was 1.6%. When chemoprophylaxis and/or mechanical prophylaxis were given, DVT rate was 8.6% (p \textless 0.0189) and PE was 1.3% (p = 0.4462). PE proportions were not decreased with mechanical prophylaxis or surveillance. DVT and PE rates were not associated (p = 0.7574). CONCLUSIONS: The results suggest that PE is not associated with lower extremity DVT in adult trauma patients.

Chemoprophylaxis; Chi Square Test; Deep vein thrombosis; Disease Surveillance – Evaluation; Emergency Patients; Fisher's Exact Test; Human; Lower Extremity – Pathology; Mechanical prophylaxis; PubMed; Pulmonary embolism; Pulmonary Embolism – Drug Therapy; Systematic Review; Ultrasound surveillance; Venous thromboembolism; Venous Thrombosis – Drug Therapy

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