A 20-year retrospective analysis of deep venous thrombosis and pulmonary embolism among combat casualties requiring damage-control laparotomy at US military Role 2 surgical units.

Autor:	Cobler-Lichter MD; From the Division of Trauma, Surgical Critical Care and Burns (M.D.C.-L., B.L.C., J.M.D., L.S., N.B.L., L.T.B., N.N., M.D.B., K.G.P., P.J.W.), Daughtry Family Department of Surgery, University of Miami Miller School of Medicine; Jackson Memorial Hospital Ryder Trauma Center (M.D.C.-L., B.L.C., J.M.D., L.S., N.B.L., L.T.B., N.N., M.D.B., K.G.P., P.J.W.); US Army Trauma Training Center (M.D.C.-L., B.L.C., J.M.D., L.S., N.B.L., L.T.B., N.N., M.D.B., K.G.P., P.J.W.), Miami, Florida; Joint Trauma System, Defense Health Agency (J.D.S., J.G.), Joint Base San Antonio-Fort Sam Houston, Texas; and Division of Trauma Surgery, Department of Surgery (K.R.G.), Cooper University Hospital, Camden, New Jersey., Collie BL, Delamater JM, Shagabayeva L, Lyons NB, Bustillos LT, Namias N, Stallings JD, Gross KR, Buzzelli MD, Gurney J, Proctor KG, Wetstein PJ
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 Aug 01; Vol. 97 (2S Suppl 1), pp. S55-S59. Date of Electronic Publication: 2024 May 24.
DOI:	10.1097/TA.0000000000004405
Abstrakt:	Background: Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population. Methods: Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2. All deaths were excluded in subsequent analysis. Rates of VTE were assessed, and subgroup analysis was performed on patients requiring massive transfusion. Results: Department of Defense Trauma Registry (n = 288) patients were young (mean age, 25 years) and predominantly male (98%) with severe (mean Injury Severity Score, 26), mostly penetrating injury (76%) and high mortality. Venous thromboembolism rate was high: 15.8% (DVT, 10.3%; pulmonary embolism, 7.1%). In the massively transfused population, the VTE rate was even higher (26.7% vs. 10.2%, p < 0.001). Conclusion: This is the first report that combat casualties requiring damage-control laparotomy at R2 have such high VTE rates. Therefore, for military casualties, we propose screening ultrasound upon arrival to each subsequent capable echelon of care and low threshold for initiating thromboprophylaxis. Level of Evidence: Prognostic and Epidemiological; Level IV. (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)
Databáze:	MEDLINE
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