Development of Deep Vein Thrombosis in Severely Injured Multiple Trauma Patients

중증외상 환자에서 심부정맥혈전 발생에 관한 고찰

  • Kim, Sangnyun (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Dongun (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Bumchul (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jungbae (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Shin, Sujeong (Department of Emergency Medicine, School of Medicine, Kyungpook National University)
  • 김상년 (경북대학교 의학전문대학원 응급의학교실) ;
  • 이동언 (경북대학교 의학전문대학원 응급의학교실) ;
  • 이범철 (경북대학교 의학전문대학원 응급의학교실) ;
  • 박정배 (경북대학교 의학전문대학원 응급의학교실) ;
  • 신수정 (경북대학교 의학전문대학원 응급의학교실)
  • Received : 2012.07.31
  • Accepted : 2012.10.05
  • Published : 2012.12.31

Abstract

Purpose: Deep vein thrombosis and pulmonary thromboembolism are major causes of death after severe multiple trauma. Although various means of prevention have been presented and utilized, still, there are no standard guidelines for anticoagulation of multiple trauma because of some contraindications. Methods: A retrospective study of adult major trauma patients whose injury severity scores (ISSs) were over 16 and who had visited one university hospital in Daegu city was performed. We compared some features of patients diagnosed DVT or PTE with those of patients without DVT by computed tomography or ultra sonography. Those features included accompanying various kinds of intracranial hemorrhages, possibility of ambulation, emergent operation, early transfusion, and suspicious symptoms. Results: The mean age of the 58 subjects included in this study was $50.9{\pm}17.2years$, the mean ISS was $22.7{\pm}6.0$, and the mean hospital stay was $55.2{\pm}37.9days$. Ten(17.2%) patients had emergent surgery, and 44(75.9%) experienced delayed surgery. Early transfusion was needed in 34(58.6%) patients. Among the 18 patients diagnosed with DVT, accompanying intracranial hemorrhages were noted in 8(44.4%) patients; one of the 8 also had PTE. Among the same 18 patients, early transfusions were required in 11(61.1%) patients; one of the 11 also had PTE. Conclusion: The risk of DVT is increased in cases of severe multiple trauma, and many difficulties in applying anticoagulants are experienced. Though we need additional studies to decide proper prophylaxis for DVT and PTE, if the patient's general condition permits, a screening test for DVT as soon as possible could be an effective method to reduce the possibility of a bad outcome.

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