Utility of IVC Filter Insertion in Patients with Traumatic Spinal Cord Injury: An Analysis of the American College of Surgeons National Trauma Data Bank
Ravi N. Kapadia, MD, Michael J. Zeidman, MD, Amit R. Shah, MD, Aksim G. Rivera, MD, FACS.
Jacobi Medical Center, Bronx, NY, USA.
OBJECTIVES: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients. Patients with traumatic spinal cord injury (SCI) are at risk for developing deep vein thrombosis (DVT). Some guidelines dictate holding chemical DVT prophylaxis for at least 72 hrs. Some institutions, mandate prophylactic IVC filter insertion. This procedure is not without complications and can increase cost and morbidity in critically ill patients. For these reasons, we set out to investigate the utility of IVC filter and the incidence of DVT/PE following SCI. METHODS: We accessed the National Trauma Data Bank and conducted a retrospective review of 3,646,495 patients between 2008 and 2012. We identified patients with traumatic spinal cord injury using ICD-9 codes representing spinal cord injury with and without bone damage (806 and 952 series). Additionally, we identified patients with IVC filter placement (Pcode 38.7), deep venous thrombosis (complication key code 14) and pulmonary emboli (complication Key code 21).Data was compared using chi square analysis. RESULTS: 59,600 cases with SCI were identified. Mean age was 44.1 (SD 20.9) with 74% (n=44,470) being male gender(p<0.01) and 17.3% (n=10,298) African-American. 3.5% (n= 2,106) of patients with SCI were complicated by DVT. Of those, 44.2% (n=930) with DVT underwent IVC filter insertion. Pulmonary embolism occurred in 10.1% (n=94) despite IVC filter insertion versus 7.6% (n=89) in patients without IVC filter placement (p=0.040). Mortality occurred in 5.6% of SCI patients (n= 52) with DVT who had undergone IVC filter insertion vs 7.8% of SCI patients who did not receive a filter (p=0.044). The number needed to treat to prevent one death was 45.5.
CONCLUSIONS:
Patients with traumatic SCI harbor an increased risk of DVT and PE, as demonstrated in previous studies. As a result many institutions mandate IVC filter insertion to prevent thromboembolic events. Our findings demonstrate a higher rate of pulmonary embolism in SCI patients who had IVC filter insertion in comparison to SCI patients treated with chemical prophylaxis alone. Therefore, we recommend instituting early chemical and mechanical DVT prophylaxis in patients with traumatic SCI.
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