Current practice variations in venous thromboembolism prophylaxis for adolescents with severe traumatic brain injury: Trauma center type matters.

IF 3.7 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2025-09-01 Epub Date: 2025-03-10 DOI:10.1097/TA.0000000000004586

Morihiro Katsura, Shingo Fukuma, Shin Miyata, Tatsuyoshi Ikenoue, Sindhu Daggupati, Matthew J Martin, Kenji Inaba, Kazuhide Matsushima

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Abstract

Background: While severe traumatic brain injury (TBI) faces an increased risk of venous thromboembolism (VTE), pharmacological VTE prophylaxis might be significantly delayed because of concerns for TBI progression. We aimed to assess practice variations in the rate and timing of VTE prophylaxis for adolescent patients with severe TBI between different trauma center types.

Methods: This retrospective cohort study using the American College of Surgeon Trauma Quality Improvement Program database (2017-2021) included patients aged 14 to 18 years with severe TBI. Trauma centers were classified as follows: adult trauma center (ATC), mixed trauma center (MTC), and pediatric trauma center (PTC). We developed a multilevel mixed-effect Poisson regression model to assess the association between trauma center type and the rate and timing of VTE prophylaxis. Effect sizes for fixed effects were reported as adjusted incidence rate ratio (aIRR) with 95% confidence interval (CI). Secondary outcomes included the incidence of VTE and late neurosurgical interventions (>72 hours).

Results: Of 7,238 eligible patients, pharmacological VTE prophylaxis was performed in 63.1% at ATC, 59.0% at MTC, and 28.5% at PTC. The median time to the initial prophylaxis was 4 days at ATC, 4 days at MTC, and 6 days at PTC ( p < 0.001). In the regression model, treatment at MTC and PTC was associated with decreased likelihood of VTE prophylaxis (aIRR, 0.89 [95% CI, 0.80-0.97] and aIRR, 0.39 [95% CI, 0.32-0.47]) compared with ATC. Treatment at PTC was associated with higher odds of VTE events (odds ratio, 2.04; 95% CI, 1.16-3.60), while there was no significant difference in the rate of late neurosurgical interventions between ATC and PTC (odds ratio, 1.18; 95% CI, 0.68-2.05).

Conclusion: We observed significant practice variations in the use of pharmacological VTE prophylaxis for adolescent patients with severe TBI between ATC, MTC, and PTC. Further research is warranted to investigate potential drivers of these variations and develop standardized protocols.

Level of evidence: Therapeutic/Care management; Level III.

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目前的实践变化静脉血栓栓塞预防青少年严重创伤性脑损伤：创伤中心类型的问题。

背景：当严重创伤性脑损伤（TBI）面临静脉血栓栓塞（VTE）的风险增加时，由于对TBI进展的担忧，静脉血栓栓塞的药理学预防可能会显著延迟。我们的目的是评估不同创伤中心类型之间青少年严重TBI患者静脉血栓栓塞预防率和时间的实践差异。方法：这项回顾性队列研究使用美国外科学会创伤质量改善计划数据库（2017-2021），纳入了14至18岁的严重TBI患者。创伤中心分为成人创伤中心（ATC）、混合创伤中心（MTC）和儿童创伤中心（PTC）。我们开发了一个多水平混合效应泊松回归模型来评估创伤中心类型与静脉血栓栓塞预防率和时间之间的关系。固定效应的效应量以校正发病率比（aIRR）报告，95%可信区间（CI）。次要结局包括静脉血栓栓塞（VTE）的发生率和晚期神经外科干预（bbb72小时）。结果：在7238例符合条件的患者中，63.1%的ATC患者、59.0%的MTC患者和28.5%的PTC患者进行了静脉血栓栓塞药物预防。ATC组到初始预防的中位时间为4天，MTC组为4天，PTC组为6天（p < 0.001）。在回归模型中，与ATC相比，MTC和PTC治疗与VTE预防可能性降低相关（aIRR, 0.89 [95% CI, 0.80-0.97]和aIRR， 0.39 [95% CI, 0.32-0.47]）。PTC治疗与静脉血栓栓塞事件发生率增高相关(优势比2.04；95% CI, 1.16-3.60)，而ATC和PTC的晚期神经外科干预率无显著差异(优势比，1.18；95% ci, 0.68-2.05)。结论：我们观察到ATC、MTC和PTC在青少年严重TBI患者使用静脉血栓栓塞药理学预防方面存在显著的实践差异。有必要进一步研究这些变化的潜在驱动因素并制定标准化方案。证据水平：治疗/护理管理；第三层次。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.