Compliance with venous thromboembolism chemoprophylaxis guidelines in non-operative traumatic brain injury.
Clin Neurol Neurosurg
; 215: 107212, 2022 04.
Article
in English
| MEDLINE | ID: covidwho-1763637
ABSTRACT
OBJECTIVE:
To determine the level of compliance of The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) for initiation of venous thromboembolism (VTE) prophylaxis after non-operative traumatic brain injury (TBI) and the explanation for the deviations.METHODS:
A retrospective review from May 2018 to February 2020 in a Level II trauma center for patients with TBI and length of stay of more than 24â¯h. We performed an analysis of overall and subgroup compliance with guidelines. The ACS TQIP criteria for low and moderate-risk for hemorrhagic progression were used for subgroup classification.RESULTS:
Of 393 patients, 239 (60.8%) patients received chemoprophylaxis in a mean of 64 (SD +/-42) hours since admission. "Compliance" was achieved in 52.2% of patients. In subgroup analysis, 51.4% of patients in "low-risk" and 55.1% in "moderate-risk" were "compliant." The most common rationale for non-compliance in "low-risk" was a stay less than 48â¯h in 35.9% of patients. However, in "moderate-risk," the most common non-compliance was starting prophylaxis before the recommended 72â¯h from admission in 37% of cases.CONCLUSIONS:
Guidelines streamline clinical practice to optimize outcomes, but there are scenarios in which deviation of the recommendations may be indicated based on clinical judgment. We show that a stay of less than 48â¯h was the most common rationale for not starting prophylaxis in "low-risk" patients. However, in the "moderate-risk" subgroup, the most common reason was starting chemoprophylaxis before the recommended time frame, which we called a "paradoxical" non-compliance.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Venous Thromboembolism
/
Brain Injuries, Traumatic
Type of study:
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Clin Neurol Neurosurg
Year:
2022
Document Type:
Article
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