e-Article
Venous thromboembolism testing practices after orthopaedic trauma: prophylaxis regimen does not influence testing patterns
Document Type
article
Author
Bryce E. Haac, MD; Nathan N. O'Hara, PhD, MHA; Elliott R. Haut, MD, MPH; Theodore T. Manson, MD; Gerard P. Slobogean, MD; Robert V. O'Toole, MD; Deborah M. Stein, MD, MPH; ADAPT Investigators; Herman Johal; Richard Van Besien; Peter Z. Berger; George B. Reahl; Dimitrius Marinos; Yasmin Degani; Daniel Mascarenhas; Daniel Connelly; Thomas M. Scalea
Source
OTA International, Vol 7, Iss 2 (2024)
Subject
Language
English
ISSN
2574-2167
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Abstract
Abstract. Objectives:. To determine venous thromboembolism (VTE) testing patterns in an orthopaedic trauma population and to evaluate for differences in VTE surveillance by prophylaxis regimen through a secondary analysis of the ADAPT trial. Design:. Prospective randomized trial. Setting:. Level I trauma center. Patients:. Three hundred twenty-nine adult (18 years and older) trauma patients presenting with an operative extremity fracture proximal to the metatarsals/carpals or any pelvic or acetabular fracture requiring VTE prophylaxis. Intervention:. VTE imaging studies recorded within 90 days post injury. Main Outcome Measurements:. Percentage of patients tested for VTE were compared between treatment groups using Fisher's exact test. Subsequently, multivariable regression was used to determine patient factors significantly associated with risk of receiving a VTE imaging study. Results:. Sixty-seven patients (20.4%) had VTE tests ordered during the study period. Twenty (29.9%) of these 67 patients with ordered VTE imaging tests had a positive finding. No difference in proportion of patients tested for VTE by prophylaxis regimen (18.8% on aspirin vs. 22.0% on LMWH, P = 0.50) was observed. Factors associated with increased likelihood of VTE testing included White race (adjusted odds ratio [aOR]: 2.61, 95% CI: 1.26–5.42), increased Injury Severity Score (aOR for every 1-point increase: 1.10, 95% CI: 1.05–1.15), and lower socioeconomic status based on the Area Deprivation Index (aOR for every 10-point increase: 1.14, 95% CI: 1.00–1.30). Conclusions:. VTE surveillance did not significantly differ by prophylaxis regimen. Patient demographic factors including race, injury severity, and socioeconomic status were associated with differences in VTE surveillance. Level of Evidence:. Level I, Therapeutic.