Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

Background. The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. Materials and Methods. We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. Results. We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Conclusions. Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings

Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

Background. The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. Materials and Methods. We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. Results. We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Conclusions. Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings

Influence of pre-operative diagnosis and frozen section on operative management of pancreatic cystic lesions

Background. Frozen section analysis of cyst wall has been advocated as standard of care prior to surgical drainage of pancreatic pseudocysts. Recent studies have indicated that frozen section may be unreliable. Our aim was to investigate the role and accuracy of frozen section analysis of the cyst wall in the operative management of pancreatic cystic lesions. Methods. A retrospective review was performed of 44 patients who underwent operation for a cystic lesion of the pancreas. Results. Of the 25 patients with a diagnosis of pseudocyst, 9 patients had frozen section intra-operatively. Eight frozen sections demonstrated pseudocyst, and correlated with final pathology. One frozen section demonstrated a true cyst. Twenty-three patients had a final diagnosis of pseudocyst. Nineteen patients had a diagnosis of cystic neoplasm, and six patients had frozen sections. Three frozen sections were consistent with cystic neoplasm and correlated with final pathology. Three frozen sections demonstrated characteristics of pseudocyst, two correlated with final pathology, and one showed cystic neoplasm on final pathology. Conclusion. Routine use of frozen section may not be necessary; however, frozen section is useful when the intra-operative appearance does not correlate with pre-operative diagnosis