Highlights
- •Prophylactic insertion of inferior vena cava filters (IVCF) in specific trauma patients with severe intracranial injuries, spinal cord injuries, and pelvic/lower extremity fractures may be negatively associated with overall mortality and positively associated with overall venous thromboembolism rates.
- •Prophylactic insertion of IVCFs in our sample decreased over time, consistent with previous studies showing decreasing insertion rates in the general trauma patient population and medical inpatients.
- •Further investigation into which specific trauma patients, if any, may benefit from prophylactic IVCF insertion would be aided by a multi-institutional database containing information specific to IVCF use in trauma patients with the specific injury types described in our study sample.
Abstract
Purpose
To determine relationships between prophylactic inferior vena cava filter (IVCF) insertion
and pulmonary embolism (PE), deep venous thrombosis (DVT), and in-hospital mortality
outcomes in patients with severe traumatic pelvic/lower extremity, intracranial, and
spinal cord injuries.
Methods
Adult patients with severe traumatic pelvic/lower extremity, intracranial, and spinal
cord injuries admitted to level I-IV trauma centers were selected from the National
Trauma Data Bank (NTDB). IVCFs that were inserted both ≤48 h after admission and before
a lower extremity venous ultrasound were defined as prophylactic. Associations between
prophylactic IVCF insertion and PE, DVT, and overall mortality outcomes during admission
were estimated using logistic regression models after propensity score matching. Additionally,
factors predictive of prophylactic IVCF insertion were estimated using multivariate
logistic regression.
Results
Of 462,838 patients, 11,938 (2.6%) underwent prophylactic IVCF insertion. Prophylactic
IVCF utilization decreased over time (6.3% in 2008 to 1.8% in 2015). Factors associated
with prophylactic IVCF placement were injury pattern, trauma center level/region,
Injury Severity Score, and race. Prophylactic IVCF placement was positively associated
with PE (Odds Ratio (OR): 5.25, p < 0.01) and DVT (OR: 5.55, p < 0.01), but negatively associated with in-hospital mortality compared to the propensity
score-matched control group (OR: 0.46, p < 0.01).
Conclusion
Prophylactic IVCF insertion in adult patients with severe pelvic/lower extremity fractures,
intracranial injuries, and spinal cord injuries was negatively associated with in-hospital
mortality, but positively associated with VTE. Further research evaluating the use
of prophylactic IVCF placement in trauma patients with these specific severe injury
types may be warranted.
Keywords
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Article Info
Publication History
Accepted:
August 2,
2022
Received in revised form:
July 31,
2022
Received:
April 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
