Robert Meek, MBBS, FACEM, MClinEpi, Adjunct Lecturer, Emergency Physician; Roger Lien-Kien Tong, MBBS, Emergency Medicine Registrar.
Venous thromboembolism in emergency department patients with rigid immobilization for lower leg injury: Incidence and risk factors
Article first published online: 28 FEB 2012
© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 24, Issue 3, pages 277–284, June 2012
How to Cite
Meek, R. and Tong, R. L.-K. (2012), Venous thromboembolism in emergency department patients with rigid immobilization for lower leg injury: Incidence and risk factors. Emergency Medicine Australasia, 24: 277–284. doi: 10.1111/j.1742-6723.2012.01539.x
- Issue published online: 3 JUN 2012
- Article first published online: 28 FEB 2012
- Accepted 8 January 2012
- hospital emergency service;
- leg injury;
- venous thromboembolism
Objectives: To determine the incidence and risk factors for symptomatic venous thromboembolism (VTE) in adults who are discharged from the ED with rigid immobilization for lower limb injury.
Methods: Eligible patients presenting between 1 December 2008 and 31 December 2010 were identified retrospectively from the Southern Health ED (Monash Medical Centre, Dandenong Hospital, Casey Hospital, all located in Melbourne, Australia) information system. Age, sex, diagnosis, type of splint and other defined potential VTE risk factors were recorded. VTE was confirmed from archived diagnostic imaging or hospital re-attendance records. Patients presenting between 1 October 2010 and 31 December 2010 were contacted to detect VTE diagnosed and treated outside of Southern Health. VTE incidence is reported, and comparison of risk factors performed.
Results: VTE was initially confirmed in 33 of 1231 patients (2.7%, 95% confidence interval 1.9–3.7). VTE was reported by 3 of 174 in the contacted subgroup (1.7%, 0.4–4.6). Applying this ‘missed rate’ to the whole sample, the estimated VTE incidence is between 3.1% and 7.1%. Multivariate risk factor analysis found VTE risk to increase with age and a diagnosis of Achilles tendon rupture.
Conclusion: The estimated VTE incidence was between 3% and 7% in this ED population with age and diagnosis of Achilles tendon rupture increasing risk. Prospective research to more accurately determine incidence, severity and risk stratification is required before firm recommendations on the likely risk versus benefit profile of thromboprophylaxis can be made for this population.