Deep venous thrombosis (DVT) of the lower extremities is a common cause of morbidity and mortality among neurologically injured patients. The data on incidence and prevalence rates of DVT among high risk neurologic populations is scarce. The available literature focuses largely on patients admitted to a medical or surgical intensive care unit with very limited information on patients in neuro-intensive care units (NICU). The aim of the present study is to assess the incidence and prevalence of deep vein thrombosis among patients admitted with acute neurologic injury.
We conducted a retrospective review of ultrasound records of 2,644 patients admitted to NICU, stroke or INICU at a university hospital over a 13-month period. We included all patients who underwent routine lower extremity ultrasound on admission and weekly. Data was abstracted and analyzed to assess the prevalence of DVT in this period. We excluded patients presenting with superficial vein thrombosis, hematoma and chronic venous scarring.
Among the 2,644 patients studied, 161 were diagnosed with DVT. The overall prevalence of DVT was 6.1%. Of the 161 cases of DVT; 87 (54%) were diagnosed with DVT at the time of admission. In our sample, the rate of DVT present on admission was 3.3%. There were 74 cases of hospital-acquired DVT, yielding an incidence of 2.8%. Patients with DVT at the time of admission were largely Caucasian males with mean age 72 and mean SAPS II score of 34.2, ranging between 13 and 71.
Patients admitted to a neuro ICU are at high risk for having DVT present on admission and for acquiring DVT during their hospitalization. Further research is needed to understand the risk profile of patients with acute neurological injury. Asymptomatic screening of high risk patients on admission to a neurologic ICU, stroke unit, or intermediate care unit will identify a significant number of cases of DVT present of admission that might otherwise be misidentified as hospital acquired cases.
Dolla, MD, Aman and Vibbert, MD, Matthew
"Incidence and Prevalence of Deep Vein Thrombosis Among Neurocritical Intensive Care Unit Patients,"
JHN Journal: Vol. 12
, Article 9.
Available at: http://jdc.jefferson.edu/jhnj/vol12/iss1/9