- •The results of this study support a high incidence of deep vein thrombosis by screening ultrasonography and support performing screening duplex ultrasound on admission to rehabilitation.
- •Risk factors for venous thromboembolism in brain injury include age at injury, body mass index, injury etiology, history of neurosurgical procedure, and surgery during inpatient rehabilitation.
- •Prospective research is needed to confirm these findings and inform clinical practice guidelines.
To determine the incidence of VTE in the population with brain injuries (BIs) using ultrasonography, and to assess the risk of pulmonary embolism (PE) development and/or bleeding complications related to anticoagulation.
Acute rehabilitation hospital.
238 individuals with moderate to severe BI who were routinely screened for VTE with ultrasonography on admission to rehabilitation (N=238).
Main Outcome Measures
Retrospective chart review was performed to identify individuals who were diagnosed with VTE at the following 3 time points: in acute care prior to admission to rehabilitation, at the time of admission diagnosed via screening examination, and after admission to rehabilitation. Additionally, risk factors for VTE, PE, and incidence of bleeding complications related to therapeutic anticoagulation were assessed.
123 deep vein thromboses (DVTs) were identified with 38.2% in acute care (n=47), 69.1% on admission to rehabilitation (n=85), and 7.3% during the course of rehabilitation stay (n=9). Risk factors for development of VTE included age at injury, body mass index, injury etiology, history of neurosurgical procedure, and surgery during inpatient rehabilitation. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE (n=50), 2% developed recurrent DVT and 2% had bleeding complications. There was zero incidence of PE.
We demonstrated a high prevalence of VTEs identified on screening ultrasonography on admission to inpatient rehabilitation among individuals with moderate to severe BIs, and low complications related to anticoagulation. Given the findings of this study, prospective research in ultrasonography screening for VTE in moderate to severe BI is needed.
List of abbreviations:BMI (body mass index), BI (brain injury), CTA (computerized tomography angiography), DVT (deep vein thrombosis), PE (pulmonary embolism), TBI (traumatic brain injury), VP (ventriculoperitoneal)
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Published online: January 31, 2023
Accepted: January 5, 2023
Received in revised form: December 7, 2022
Received: August 8, 2022
Publication stageIn Press Journal Pre-Proof
This work was supported by the Craig Hospital Foundation under grant number 2643.
© 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine