ABSTRACT
Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. Trauma and Nontrauma patients who had a retrievable IVCF placed during 2006 were identified. A protocol existed for trauma patients with chart stickers, arm bracelets, and dedicated follow-up by nurse practitioners from three trauma teams. No protocol existed for nontrauma patients. Statistical analysis was performed using χ(2) analysis or analysis of variance. One hundred sixty-seven retrievable IVCFs were placed over 12 months; 91 in trauma patients and 76 in nontrauma patients. Trauma patients were more likely to have their IVCF removed than nontrauma patients, 55 per cent versus 19 per cent, P < 0.001. There were differences between the three trauma teams, with removal rates of 44 per cent, 42 per cent, and 86 per cent respectively (P < 0.05). On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.
Subject(s)
Device Removal/methods , Multiple Trauma/surgery , Pulmonary Embolism/prevention & control , Vena Cava Filters/statistics & numerical data , Adult , Aged , Cohort Studies , Critical Care/methods , Device Removal/statistics & numerical data , Female , Follow-Up Studies , Health Policy , Humans , Intensive Care Units , Male , Middle Aged , Multiple Trauma/mortality , Multivariate Analysis , Predictive Value of Tests , Pulmonary Embolism/mortality , Retrospective Studies , Risk Assessment , Survival Rate , Treatment Outcome , Wounds and Injuries/diagnosis , Wounds and Injuries/surgeryABSTRACT
Impaired mitochondrial activity has been linked to increased risk for clinical complications after injury. Furthermore, variant mitochondrial alleles have been identified and are thought to result in decreased mitochondrial activity. These include a nonsynonymous mitochondrial polymorphism (T4216C) in the nicotinamide adenine dinucleotide dehydrogenase 1 gene (ND1), encoding a key member of complex I within the electron transport chain, which is found almost exclusively among Caucasians. We hypothesized that burn patients carrying ND1 4216C are less able to generate the cellular energy necessary for an effective immune response and are at increased risk for infectious complications. The association between 4216C and outcome after burn injury was evaluated in a cohort of 175 Caucasian patients admitted to the Parkland Hospital with burns covering greater than or equal to 15% of their total body surface area or greater than or equal to 5% full-thickness burns under an institutional review board-approved protocol. To remove confounding unrelated to burn injury, individuals were excluded if they presented with significant non-burn-related trauma (Injury Severity Score > or =16), traumatic or anoxic brain injury, spinal cord injury, were HIV/AIDS positive, had active malignancy, or survived less than 48 h postadmission. Within this cohort of patients, carriage of the 4216C allele was significantly associated by unadjusted analysis with increased risk for sepsis-related organ dysfunction or septic shock (P = 0.011). After adjustment for full-thickness burn size, inhalation injury, age, and sex, carriage of the 4216C allele was associated with complicated sepsis (adjusted odds ratio = 3.7; 95% confidence interval, 1.5-9.1; P = 0.005), relative to carriers of the T allele.
