Venous thromboembolism (VTE) is a well-established cause of morbidity and mortality in the trauma patient. Soldiers injured in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are often aeromedically evacuated shortly posttrauma, subjecting them to lengthy transport and potential hypobaric hypoxia during the period of peak thrombogenesis. We sought to determine the observed incidence of VTE in soldiers injured in OEF and OIF who were admitted to the intensive care unit (ICU) of our military tertiary care facility.
We retrospectively identified all patients injured in OEF and OIF admitted directly to the ICU at our institution for the 16-month period between 28 March 2003 and 28 July 2004. Relevant variables determined from chart review included mechanism of injury, location of primary and secondary injuries, Revised Trauma Score, type of VTE prophylaxis, and radiographic studies performed. All cases of VTE and death were recorded.
During the study period 231 trauma patients from OEF and OIF were admitted to the ICU. Forty patients (17.3%) developed VTE during hospitalization at our facility. Overall mortality was 2.2%. One of these five deaths was from pulmonary embolism. The most commonly used form of prophylaxis was enoxaparin (30 mg SQ BID). Inferior vena cava filters were placed infrequently. There was no observed difference in development of VTE between patients who received pharmacologic prophylaxis and those who did not (22/130, 16.9% vs. 18/101, 17.8%; p=0.863).
VTE is common in the critically ill OEF/OIF population and incidence appears similar to that of civilian trauma populations. The VTE-related mortality appears to be low.
Despite the high severity of injury, the rate of VTE in this population is no higher than that reported in other settings. VTE infrequently results in mortality. Ideal means of prophylaxis in this trauma population should be reassessed.
William Jackson, Jr., None.