Deep Venous Thrombosis (DVT) in Trauma: a Literature Review

Ultrasound (U/S)

First Author	Year	Reference Title	Class	Conclusions
Wheeler HB	1995	Diagnostic methods for deep vein thrombosis. Haemostasis 25:6-26	I	Review article summarizing series examining U/S (duplex and Doppler) comparing results in symptomatic and asymptomatic patients. Compared U/S to other diagnostic modalities for DVT.
Comerota AJ	1993	Venous duplex imaging for the diagnosis of acute deep venous thrombosis. Haemostasis 23:61-7	I	Review of meta-analysis of cumulative series comparing U/S to phlebography. Sensitivity, specificity, positive predictive value and È are reported on symptomatic and asymptomatic patients with DVT.
Agnelli G	1995	Diagnosis of deep vein thrombosis in asymptomatic high-risk patients. Haemostasis 25:40-8	I	Review of both U/S and IPG studies which were classified as Level I or Level II by author. Both U/S and IPG proved low sensitivity in detecting asymptomatic DVT in meta-analysis.
Burns GA	1993	Prospective ultrasound evaluation of venous thrombosis in high-risk trauma patients. J Trauma 35:405-8	III	58 high risk trauma patients underwent total body bi-weekly Doppler U/S. There was a 21% incidence of DVT, all occult. 23% of patients had incomplete U/S exams.
Napolitano LM	1995	Asymptomatic deep venous thrombosis in the trauma patient: Is an aggressive screening protocol justified? J Trauma 39:651-9	III	Retrospective review of serial U/S performed on trauma patients admitted to ICU. 10% DVT rate multiple logistic regression revealed ISS, length of stay, Trauma Score and spinal cord injury as risk factors.
Meythaler JM	1996	Cost-effectiveness of routine screening for proximal deep venous thrombosis in acquired brain injury patients admitted to rehabilitation. Arch Phys Med Rehabil 77:1-5	II	8.5% of head-injured patients admitted to rehab have DVT on screening duplex U/S. Cost analysis revealed routine screening for DVT in this patient population was more cost-effective than screening for either breast cancer or colorectal cancer.
White RH	1990	Deep-vein thrombosis after fracture of the pelvis: Assessment with serial duplex-ultrasound screening. J Bone Joint Surg 72A:495-500	III	60 pelvic fractures screened with duplex U/S. 15% DVT rate; 1 PE noted in patient who became positive on duplex that day.

Ultrasound (U/S)

First Author	Year	Reference Title	Class	Conclusions
Chu DA	1985	Deep venous thrombosis: Diagnosis in spinal cord injured patients. Arch Phys Med Rehabil 66:365-8	III	Systematic clinical exam for DVT was successful in diagnosing 2 DVTs out of 21 patients. Both were confirmed with Doppler U/S.
Myllynen PM	1985	Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: A comparison with nonparalyzed patients immobilized due to spinal fractures. J Trauma 25:541-3	II	23 patients with acute spinal cord injury had a 100% incidence of DVT diagnosed with 125I-labeled fibrinogen and confirmed with venography.
Brach BB	1977	Venous thrombosis in acute spinal cord paralysis. J Trauma 17:289-92	III	9/10 patients had DVT by 125I-labeled fibrinogen and 7 were confirmed with venography.
Meredith JW	1993	Femoral catheters and deep venous thrombosis: A prospective evaluation of venous duplex sonography. J Trauma 35:187-91	III	Serial B-mode duplex U/S showed a 14% incidence of ileofemoral DVT on the side of 8F femoral venous catheter.
Dorfman GS	1990	Lower-extremity venous thrombosis in patients with acute hip fractures: Determination of anatomic location and time of onset with compression sonography. AJR Am J Roentgenol 154:851-5	II	Serial compression sonography revealed 19% DVT rate (all occult) which were confirmed with venogram.
Jongbloets LM	1994	Limitations of compression ultrasound for the detection of symptomless postoperative deep vein thrombosis. Lancet 343:1142-4	II	U/S had only 38% sensitivity in detecting DVT in postop craniotomy patients when compared to venography. Authors conclude that U/S is not useful in screening for DVT in high risk asymptomatic postop patients.
Dennis JW	1993	Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high risk groups. J Trauma 35:132-9	III	281 high risk trauma patients screened with duplex or Doppler U/S revealed 4.6% incidence of DVT and 6% incidence of PE. Of those patients with PE (all fatal), none had DVT by U/S.
Knudson MM	1992	Thromboembolism following multiple trauma. J Trauma 32:2-11	II	Prospective U/S evaluation in 113 patients identifying risk factors for DVT (age, # days immobilized, # transfusions, abnormal admission clotting studies).
Knudson MM	1994	Prevention of venous thromboembolism in trauma patients. J Trauma 37:480-7	II	Prospective evaluation of different prophylactic methods for DVT in high risk patients. Patients were followed with serial duplex U/S.