The increasing use of vena cava filters in adult trauma victims: Data from the American college of Surgeons National Trauma Data Bank

Background: Vena cava filters (VCFs) have been advocated for prophylaxis of pulmonary embolism in trauma patients at high risk for venous thrombosis in whom anticoagulation is contraindicated or not feasible. We sought to determine the frequency of VCF insertion and patterns of use in trauma patients using a large database. Methods: Retrospective analysis of data from the National Trauma Data Bank of the American College of Surgeons on patients over the age of 17 years from 1991 to 2002. We examined the annual frequency of VCF placement, the demo-graphics and injury severity of patients receiving them, and the characteristics of the hospitals at which they were being placed. Results: Of 614,349 patients, 6,282 received a VCF (1%); 86% were placed prophylactically (without an associated discharge diagnosis of either pulmonary embolism or venous thrombosis). Filter use increased significantly from 0.3% of patients in 1994 to 1.2% in 2002 (p < 0.001). There was substantial variation in clinical practice with regard to placement of VCF according to injury type and its perceived risk of venous thromboembolism. VCFs were placed significantly more frequently at hospitals verified as Level I trauma centers. Conclusion: VCF insertion has increased significantly during the past 10 years in trauma patients reported to the National Trauma Data Bank. The lack of an evidence-based guideline for their use has resulted in a wide variation in practice. Such variation in practice indicates the need for a consensus conference or a multicenter prospective clinical trial to determine their role in trauma patients.