Jakob, Dominik A; Müller, Martin; Lewis, Meghan; Wong, Monica D; Exadaktylos, Aristomenis; Demetriades, Demetrios (2024). Risk factors for thromboembolic complications in isolated severe head injury. European journal of trauma and emergency surgery, 50(1), pp. 185-195. Springer-Medizin-Verlag 10.1007/s00068-023-02292-y
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PURPOSE
Patients with traumatic brain injury (TBI) are at high risk for venous thromboembolism (VTE). The aim of the present study is to identify factors independently associated with VTE events. Specifically, we hypothesized that the mechanism of penetrating head trauma might be an independent factor associated with increased VTE events when compared with blunt head trauma.
METHODS
The ACS-TQIP database (2013-2019) was queried for all patients with isolated severe head injuries (AIS 3-5) who received VTE prophylaxis with either unfractionated heparin or low-molecular-weight heparin. Transfers, patients who died within 72 h and those with a hospital length of stay < 48 h were excluded. Multivariable analysis was used as the primary analysis to identify independent risk factors for VTE in isolated severe TBI.
RESULTS
A total of 75,570 patients were included in the study, 71,593 (94.7%) with blunt and 3977 (5.3%) with penetrating isolated TBI. Penetrating trauma mechanism (OR 1.49, CI 95% 1.26-1.77), increasing age (age 16-45: reference; age > 45-65: OR 1.65, CI 95% 1.48-1.85; age > 65-75: OR 1.71, CI 95% 1.45-2.02; age > 75: OR 1.73, CI 95% 1.44-2.07), male gender (OR 1.53, CI 95% 1.36-1.72), obesity (OR 1.35, CI 95% 1.22-1.51), tachycardia (OR 1.31, CI 95% 1.13-1.51), increasing head AIS (AIS 3: reference; AIS 4: OR 1.52, CI 95% 1.35-1.72; AIS 5: OR 1.76, CI 95% 1.54-2.01), associated moderate injuries (AIS = 2) of the abdomen (OR 1.31, CI 95% 1.04-1.66), spine (OR 1.35, CI 95% 1.19-1.53), upper extremity (OR 1.16, CI 95% 1.02-1.31), lower extremity (OR 1.46, CI 95% 1.26-1.68), craniectomy/craniotomy or ICP monitoring (OR 2.96, CI 95% 2.65-3.31) and pre-existing hypertension (OR 1.18, CI 95% 1.05-1.32) were identified as independent risk factors for VTE complications in isolated severe head injury. Increasing GCS (OR 0.93, CI 95% 0.92-0.94), early VTE prophylaxis (OR 0.48, CI 95% 0.39-0.60) and LMWH compared to heparin (OR 0.74, CI 95% 0.68-0.82) were identified as protective factors for VTE complications.
CONCLUSION
The identified factors independently associated with VTE events in isolated severe TBI need to be considered in VTE prevention measures. In penetrating TBI, an even more aggressive VTE prophylaxis management may be justified as compared to that in blunt.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center |
UniBE Contributor: |
Jakob, Dominik, Müller, Martin (B), Exadaktylos, Aristomenis |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1863-9933 |
Publisher: |
Springer-Medizin-Verlag |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
09 Jun 2023 13:01 |
Last Modified: |
09 Mar 2024 00:11 |
Publisher DOI: |
10.1007/s00068-023-02292-y |
PubMed ID: |
37289227 |
Uncontrolled Keywords: |
Deep vein thrombosis Head trauma Mechanism of injury Pulmonary embolism |
BORIS DOI: |
10.48350/183269 |
URI: |
https://boris.unibe.ch/id/eprint/183269 |
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