Sequential duplex ultrasound screening for proximal deep venous thrombosis in asymptomatic patients with acetabular and pelvic fractures treated operatively

BACKGROUND: Recent evidence-based practice guidelines recommend against routine ultrasound screening for proximal deep vein thrombosis (DVT) in asymptomatic pelvic fracture patients. However, the majority of trauma surgeons favor this practice. Furthermore, the timing of screening has been inconsistently described. The purpose of this study was to examine the utility of sequential scans in asymptomatic acetabular and pelvic fracture patients treated operatively. METHODS: In 2003, a screening protocol for DVT was begun for asymptomatic patients with these fractures treated operatively. Duplex ultrasound screening was used to evaluate the lower extremities for proximal DVT. Scans were to be obtained preoperatively and then postoperatively on the day before planned discharge from the hospital. A DVT prophylaxis protocol was also instituted. Between 2003 and 2007, 343 patients were identified for study. Patients were followed for thromboembolic complications for a minimum of 3 months. RESULTS: Two hundred twenty-nine patients received both preoperative and postoperative scans. Of these, 35 patients (15%) had an asymptomatic DVT: 16 (7%) preoperatively and 19 (8%) postoperatively. Two patients (1%) with negative scans had a postoperative symptomatic pulmonary embolism (PE) diagnosed the day after surgery, but fatal PE did not occur. In the remaining 114 patients, 27 received a prophylactic inferior vena cava filter, 6 had a preoperative symptomatic DVT or PE before scanning, 25 received only the postoperative scan (3 being positive), and 56 were not scanned postoperatively. Of the 56 not scanned postoperatively, 2 (4%) were readmitted with a symptomatic proximal DVT but none for PE, and a fatal PE did not occur. CONCLUSIONS: Despite the possible diagnostic utility of sequential duplex ultrasound screening, it does not decrease the risk of PE in acetabular and pelvic fracture patients. (J Trauma. 2012; 72: 443-447. Copyright (C) 2012 by Lippincott Williams & Wilkins)