An analysis of deep vein thrombosis in burn patients (Part 1): Comparison of D-dimer and Doppler ultrasound as screening tools

Autor: Priya Bansal, Manju Subberwal, Rajeev Ahuja, Gaurav Pradhan
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Body Surface Area
medicine.drug_class
Deep vein
Low molecular weight heparin
Critical Care and Intensive Care Medicine
Sensitivity and Specificity
Fibrin Fibrinogen Degradation Products
Young Adult
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
D-dimer
medicine
Humans
Mass Screening
Screening tool
Prospective Studies
030212 general & internal medicine
Enoxaparin
Prospective cohort study
Randomized Controlled Trials as Topic
Venous Thrombosis
Trauma Severity Indices
High prevalence
business.industry
Disease Management
Ultrasonography
Doppler
030208 emergency & critical care medicine
General Medicine
Middle Aged
medicine.disease
Thrombosis
Surgery
medicine.anatomical_structure
Emergency Medicine
Female
Doppler ultrasound
Burns
business
Zdroj: Burns. 42:1686-1692
ISSN: 0305-4179
DOI: 10.1016/j.burns.2016.08.005
Popis: Introduction The high prevalence of deep vein thrombosis (DVT) reported in prospective studies and the unreliability of clinical diagnosis mandates prospective screening for DVT in burn patients. Our study seeks to compare D-dimer and Doppler ultrasound (DUS) in search for a practical, inexpensive and a reliable screening tool. Methods One hundred burn patients (inclusion criteria: 30–60% TBSA burn, >18 years of age, admitted within 48 h of burn) were computer randomized into two equal groups. The study (prophylaxis) group received low molecular weight heparin (LMWH) (0.5 mg/kg, twice daily-max 60 mg/day) from day one, till discharge. Screening D-dimer assays and DUS of the lower extremities were performed on all 100 patients on day five, and then weekly, till discharge. Results Signs and symptoms simulating DVT (pain, swelling, redness, warmth, positive Homans’ and Moses’ sign) were present in majority of patients with lower limb burns. 43/50 patients (86%) in the control group and 38/50 patients (76%) in the study (prophylaxis) group had positive D-dimer values (>0.5 μg/ml) on the 5th post-burn day. D-dimer was positive in all the four patients identified with DVT. However, only 4/100 patients enrolled in the study demonstrated DVT on DUS. Thus, the specificity of the D-dimer assay was only 20% with a positive predictive value of 5%. Absolute D-dimer values were found to have no correlation to the extent of burns. Conclusion We conclude that D-dimer is not a useful screening tool for DVT in burns contrary to its accepted value in general trauma and medical patients.
Databáze: OpenAIRE
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