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European Journal of Trauma and Emergency Surgery

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Open Access 08-06-2023 | Central Nervous System Trauma | Original Article

Risk factors for thromboembolic complications in isolated severe head injury

Authors: Dominik A. Jakob, Martin Müller, Meghan Lewis, Monica D. Wong, Aristomenis K. Exadaktylos, Demetrios Demetriades

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2024

Abstract

Purpose

Patients with traumatic brain injury (TBI) are at high risk for venous thromboembolism (VTE). The aim of the present study is to identify factors independently associated with VTE events. Specifically, we hypothesized that the mechanism of penetrating head trauma might be an independent factor associated with increased VTE events when compared with blunt head trauma.

Methods

The ACS-TQIP database (2013–2019) was queried for all patients with isolated severe head injuries (AIS 3–5) who received VTE prophylaxis with either unfractionated heparin or low-molecular-weight heparin. Transfers, patients who died within 72 h and those with a hospital length of stay < 48 h were excluded. Multivariable analysis was used as the primary analysis to identify independent risk factors for VTE in isolated severe TBI.

Results

A total of 75,570 patients were included in the study, 71,593 (94.7%) with blunt and 3977 (5.3%) with penetrating isolated TBI. Penetrating trauma mechanism (OR 1.49, CI 95% 1.26–1.77), increasing age (age 16–45: reference; age > 45–65: OR 1.65, CI 95% 1.48–1.85; age > 65–75: OR 1.71, CI 95% 1.45–2.02; age > 75: OR 1.73, CI 95% 1.44–2.07), male gender (OR 1.53, CI 95% 1.36–1.72), obesity (OR 1.35, CI 95% 1.22–1.51), tachycardia (OR 1.31, CI 95% 1.13–1.51), increasing head AIS (AIS 3: reference; AIS 4: OR 1.52, CI 95% 1.35–1.72; AIS 5: OR 1.76, CI 95% 1.54–2.01), associated moderate injuries (AIS = 2) of the abdomen (OR 1.31, CI 95% 1.04–1.66), spine (OR 1.35, CI 95% 1.19–1.53), upper extremity (OR 1.16, CI 95% 1.02–1.31), lower extremity (OR 1.46, CI 95% 1.26–1.68), craniectomy/craniotomy or ICP monitoring (OR 2.96, CI 95% 2.65–3.31) and pre-existing hypertension (OR 1.18, CI 95% 1.05–1.32) were identified as independent risk factors for VTE complications in isolated severe head injury. Increasing GCS (OR 0.93, CI 95% 0.92–0.94), early VTE prophylaxis (OR 0.48, CI 95% 0.39–0.60) and LMWH compared to heparin (OR 0.74, CI 95% 0.68–0.82) were identified as protective factors for VTE complications.

Conclusion

The identified factors independently associated with VTE events in isolated severe TBI need to be considered in VTE prevention measures. In penetrating TBI, an even more aggressive VTE prophylaxis management may be justified as compared to that in blunt.

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Title: Risk factors for thromboembolic complications in isolated severe head injury
Authors: Dominik A. Jakob
Martin Müller
Meghan Lewis
Monica D. Wong
Aristomenis K. Exadaktylos
Demetrios Demetriades
Publication date: 08-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Intracranial Pressure Monitoring
Low Molecular Weight Heparin
Heparin
Phlebothrombosis
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2024
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-023-02292-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk factors for thromboembolic complications in isolated severe head injury

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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