Worth looking! venous thromboembolism in patients who undergo preperitoneal pelvic packing warrants screening duplex

Am J Surg. 2020 Dec;220(6):1395-1399. doi: 10.1016/j.amjsurg.2020.08.043. Epub 2020 Aug 31.

Abstract

Background: Venous thromboembolism (VTE) in patients with major pelvic fractures who undergo preperitoneal pelvic packing (PPP) has not been investigated. We hypothesized that patients who undergo PPP are at high risk for VTE, thus early prophylactic anticoagulation and screening duplex are warranted.

Study design: All patients requiring PPP from 2015 to 2019 were reviewed. Management and outcomes were analyzed.

Results: During the study period, 79 patients underwent PPP. Excluding the early deaths, 17 patients had deep venous thrombosis (DVT) and 6 had pulmonary emboli (PE); 4 patients had both DVT/PE. Overall mortality was 15%. Thirty-two patients underwent screening duplex within 72 h of admission and 10 were positive for DVT.

Conclusion: Patients with complex pelvic trauma undergoing PPP have a 23% incidence of DVT and an additional 8% incidence of PE. 31% of screening ultrasounds are positive. The overall mortality was 15%. With a high incidence of VTE in this patient population, we recommend screening duplex ultrasounds.

Keywords: Pelvic fracture; Pelvic trauma; Preperitoneal pelvic packing; Venous thromboembolism.

MeSH terms

  • Female
  • Fractures, Bone / complications*
  • Hemorrhage / mortality
  • Hemorrhage / prevention & control*
  • Hemostatic Techniques / adverse effects*
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Pelvic Bones / injuries*
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / etiology*
  • Pulmonary Embolism / mortality
  • Risk Factors
  • Ultrasonography, Doppler, Duplex*
  • Venous Thromboembolism / diagnostic imaging*
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / mortality