Adherence to guideline of venous thromboembolism prophylaxis in a level 1 Trauma center in Thailand

Objective: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication in hospitalized trauma patients. Currently, the VTE guideline is the standard of care. However, underutilization of the guideline was reported. This study aimed to report the adherence to the VTE guideline in a Level 1 trauma center in Thailand. Methods: A retrospective review was performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score 9 and admission in the hospital 7 days. The patients were classified into very high risk of DVT, high risk of DVT, and high risk of bleeding groups according to the hospital guideline. Adherence to the guideline, utility of the prophylaxis, and VTE occurrence were recorded. Results: During a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the guideline was 28.9, 5.2 in the very high risk of DVT group, 18.4 in the high risk of DVT group, and 57.9 in the high risk of bleeding group. VTE occurrence was 11 incidences in 10 patients (2.8). The high risk of bleeding group had the highest in VTE occurrence (10 of 11 incidences). Conclusions: The adherence to the VTE prophylaxis guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated as soon as possible

Scapular fractures and concomitant injuries

【Abstract】 Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients’ demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The manage-ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results: Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98±15.21) years. Motorcycle crash was the most fre-quent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular frac-tures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS>25 (LR=8.5, P<0.05); (2) significant associated chest injury (AIS>3, LR=5.3, P<0.05) and (3) significant associated ab-dominal injury (AIS>3, LR=5.3, P<0.05). Conclusion: A blunt scapular fracture may not accom-pany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality. Key words: Aortic rupture; Shoulder fractures; Mul-tiple trauma; Mortalit