Predictors of Delay to Venous Thromboembolism Prophylaxis in Patients With Traumatic Brain Injury: an Analysis of the Trauma Quality Improvement Program (TQIP)
*Matthew M. Fleming1, *Yuehong Liu2, *Yawei Zhang2,3, Kevin Y. Pei1
1Yale School of Medicine, Department of Surgery, New Haven, CT; 2Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT; 3Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
Objective: Early (<48 hours) administration of venous thromboembolism prophylaxis in moderate or severe traumatic brain injury (TBI) appears safe and is recommended. We sought to determine what factors predict delayed venous thromboembolism prophylaxis (VTEP) administration in patients suffering TBI.
Design: We performed a retrospective review of the Trauma Quality Improvement Program (2013-2016) to identify patient and hospital characteristics associated with delayed VTEP (>72 hours after admission). GCS was stratified into severe (≤8), moderate (9-12), and mild (13-15) TBI and early prophylaxis (<48 hours) was used as a reference group. Multivariate logistic regression was used to determine factors correlated with delayed VTEP.
Setting: TQIP participating hospitals.
Patients/Participants: Patients suffering TBI.
Interventions (if any): none
Main Outcome Measures: predictors of delayed VTEP.
Results: 154,781 patients were included for analysis. Patients in the moderate (OR 2.76, 95%CI 2.60-2.92) and severe (OR 1.86, 95%CI 1.76-1.98) TBI groups were at significantly increased risk for delayed VTEP. Male gender (OR 1.20, 95%CI 1.17-1.24), African American (OR 1.04, 95%CI 1.00-1.08) and Hispanic race (OR 1.07, 95%CI 1.02-1.11), surgery (OR 1.44, 95%CI 1.32-1.57) or angiography (OR 2.24, 95%CI 2.03-2.47) for hemorrhage control, and presence of an intracranial pressure monitor (OR 4.66, 95%CI 4.36-4.97) predicted delayed VTEP. University teaching status and ACS level II/III demonstrated decreased rates of delayed VTEP (OR 0.80, 95%CI 0.76-0.84 and OR 0.88, 95%CI 0.85-0.92, respectively). Rates of deep venous thrombosis (DVT) are significantly elevated in the delayed VTEP group (OR 5.39, 95%CI 5.00-5.82).
Many patients suffering TBI are receiving delayed VTEP. Patients suffering moderate and severe TBI are at increased risk of delayed VTEP and increased rates of DVT formation.