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. 2017 Jun 19;4(4):394-400.
doi: 10.1002/ams2.290. eCollection 2017 Oct.

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening

Tetsuya Yumoto  1 , Hiromichi Naito  1 , Yasuaki Yamakawa  1 , Atsuyoshi Iida  1 , Kohei Tsukahara  1 , Atsunori Nakao  1
Affiliations

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening

Tetsuya Yumoto et al. Acute Med Surg. .

Abstract

Aim: Venous thromboembolism (VTE) can be a life-threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D-dimer for screening for VTE in major trauma cases among the Japanese population.

Methods: We examined a single-center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D-dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D-dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.

Results: The study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D-dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704-0.866; P < 0.001). The cut-off that maximized the Youden index was 12.45 μg/mL.

Conclusions: At least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D-dimer levels on day 10 can be a useful predictor of VTE.

Keywords: D‐dimer; deep venous thrombosis; pulmonary embolism; trauma; venous thromboembolism.

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Figures

Figure 1
Figure 1
Flow diagram of study subjects, consisting of Japanese patients with major trauma, and workup for venous thromboembolism (VTE). CT, computed tomography; ISS, Injury Severity Score; TBI, traumatic brain injury.
Figure 2
Figure 2
Time‐to‐event data for venous thromboembolism in Japanese patients with major trauma. Black bar indicates median value. The median time from admission to venous thromboembolism diagnosis was 10 days.
Figure 3
Figure 3
Changes in D‐dimer levels from time of injury to day 14 among Japanese patients with major trauma. Patients are grouped according to the presence of venous thromboembolism ((+) VTE), without VTE by computed tomography (CT) imaging ((−) VTE), and without CT examination ((−) CT). *P < 0.05, significant difference between (+) VTE and (−) VTE groups. †P < 0.05, †††P < 0.001, significant difference between (−) VTE and (−) CT image groups.
See this image and copyright information in PMC

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