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Prophylactic IVC filter placement in patients with severe intracranial, spinal cord, and orthopedic injuries at high thromboembolic event risk: A utilization and outcomes analysis of the National Trauma Data Bank

  • Scott J. Lee
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Sijian Fan
    Affiliations
    Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
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  • Mian Guo
    Affiliations
    Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America
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  • Bill S. Majdalany
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Janice Newsome
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Richard Duszak Jr
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Judy Gichoya
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Elizabeth R. Benjamin
    Affiliations
    Division of Trauma and Surgical Critical Care, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
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  • Nima Kokabi
    Correspondence
    Corresponding author at: Emory University School of Medicine, Department of Radiology and Imaging Sciences, 550 Peachtree Street Northeast, Atlanta, GA 30322, United States of America.
    Affiliations
    Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, United States of America
    Search for articles by this author

      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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