Elevated Incidence of Chronic Deep Vein Thrombosis in Trauma Patients at UVM Medical Center
*Tovah Moss, Ajai Malhotra, *Amy T Tefft, *Andrew Stanley
University of Vermont College of Medicine, Burlington, VT
Objective: The Center for Medicare and Medicaid Services (CMS) has classified Deep Vein Thrombosis (DVT) as a Hospital Acquired Condition (HAC). CMS can deny payment for the care for DVT unless it can be demonstrated that the condition was present at admission - Chronic DVT. While there are no explicitly defined diagnostic criteria for CDVT, certain Duplex sonographic characteristics can help define a DVT as non-acute or chronic. The current study evaluates the incidence of chronic DVT among a population at high risk of DVT - traumatized patients admitted >2 days.Design: Retrospective chart review - Duplex scan results.Setting: ACS verified level-I trauma center at an academic tertiary care hospital.Patients: Adult (>18 years) traumatized patients admitted for >2 days.Interventions: None - retrospective observational study.Main Outcome Measures: Incidence of chronic DVT among traumatized patients admitted for >2 days.Results: A total of 8168 patients met entry criteria. Of these, 61 (0.7%) were positive for lower extremity DVT. Among the 61 patients with DVT, 45 (73.8%) had acute DVT, 7 (11.5%) had chronic DVT and 9 (14.7%) were indeterminate. Among the 7 patients with chronic DVT only 2 (28.6%) had a known history of DVT.Conclusions: A significant proportion (>10%) of DVTs diagnosed during acute hospitalization after major trauma are chronic in nature and the majority of these chronic DVTs are unknown to the patient. This finding has major implications for policies that can financially penalize hospital for any DVT that may be diagnosed during acute admission.
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