Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2019.1585134 · Published: May 1, 2020

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

This study aimed to find out how common deep vein thrombosis (DVT) is in spinal cord injury (SCI) patients when they start rehabilitation. The study also looked at what factors might make someone with SCI more likely to have DVT when admitted to rehab. The researchers reviewed the medical records of 189 people with traumatic SCI who had routine duplex scans to check for DVT when they were admitted to an inpatient rehabilitation center.

Study Duration

January 1, 2011 and December 31, 2016

Participants

189 individuals admitted to rehabilitation within 2 weeks of initial traumatic SCI

Evidence Level

Retrospective chart review

Key Findings

1
Older age (≥50 years old) and more severe neurological impairment (AIS A, B, and C) are independent risk factors for positive duplex screening for any (proximal and/or distal) DVT.
2
16.4% of patients had a positive scan for any DVT, with 4.8% positive for a proximal DVT and 11.6% positive for isolated distal DVT.
3
Individuals with an acute distal DVT have a high likelihood for future thrombus progression; 31.8% later developed propagation with either proximal DVTs or pulmonary embolism.

Research Summary

This retrospective study found that in acute traumatic SCI, older age and more severe neurological impairment are independent risk factors for DVT detected on rehabilitation admission. A significant portion of patients with isolated distal DVT experienced thrombus progression, highlighting the need for routine surveillance in these patients. The study suggests that routine duplex screening may be warranted for individuals at higher risk, contrary to current clinical practice guidelines.

Practical Implications

Risk Stratification

Identify SCI patients at higher risk of DVT based on age and neurological impairment for targeted screening.

Surveillance of Distal DVT

Implement routine surveillance for patients with isolated distal DVT to monitor for thrombus progression.

Re-evaluate Screening Guidelines

Consider re-evaluating clinical practice guidelines regarding routine DVT screening in high-risk SCI patients on rehabilitation admission.

Study Limitations

1
The duration of chemoprophylaxis in the acute care center prior to transfer was not determined.
2
It was not determined if patients who had duplex scans were symptomatic or asymptomatic for DVT.
3
The sample size precludes these risk factors in a multivariate framework using logistic regression.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury