Venous thromboembolism in patients with blunt trauma: are comprehensive guidelines the answer?

OBJECTIVES: This study was designed to determine the outcome of implemented guidelines for venous thromboembolism (VTE) prophylaxis. METHODS: This study was a retrospective review of a series of consecutive blunt orthopaedic trauma patients with thromboembolic complications. The patients were compared to control subjects over the same 10-year period. Univariate and multivariate statistical methods were used to determine the odds of VTE in the setting of this management guideline and risk factors for thromboembolic complications that may be refractory to this strategy. RESULTS: In the 10 years following institution of clinical management guidelines at our institution, the rate of VTE events was 3.2%, and the rate of pulmonary embolus was 0.3%. Risk factors for VTE that were refractory to our clinical management guidelines were pelvic fractures, major lower extremity injury, greater than 3 days of mechanical ventilation, increasing injury severity, and spinal cord injury. CONCLUSIONS: The implementation of a clinical management strategy for decreasing the incidence of VTE in blunt trauma patients and other potentially preventable complications is essential. Our data suggest that patients with certain injuries are particularly at risk for VTE and warrant special attention in clinical management and risk stratification, despite effective clinical management guidelines.