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Deep vein thrombosis

Prevalence and risk factors in rehabilitation admissions with brain injury

From The Brain Injury Program (Drs. Yablon and Sherer, and K.H. Goodson), Methodist Rehabilitation Center; and Departments of Neurology (Drs. Yablon and Sherer), Neurosurgery (Dr. Yablon), Pathology (Dr. Rock), and Health Sciences (Dr. Nick), University of Mississippi Medical Center, Jackson, MS. G.V. "Sonny" Montgomery Veterans Administration Medical Center (C.M. McGrath), Jackson, MS.

Address correspondence and reprint requests to Dr. Stuart A. Yablon, 1350 E. Woodrow Wilson, Jackson, MS 39216; e-mail: doctory{at}earthlink.com

Objective: To determine the prevalence and risk factors of deep vein thrombosis (DVT) among neurorehabilitation admissions with acquired brain injury (BI).

Methods: In this prospective, sequential case series, 709 consecutive initial neurorehabilitation patients with BI < 120 days—including traumatic brain injury (TBI; n = 360), intracranial hemorrhage (ICH; n = 213), primary brain tumor (n = 66), and hypoxia/other BI (n = 70)—were screened for evidence of DVT with lower extremity venous duplex ultrasonography (VDU). The admission screening protocol combined VDU and a commercial D-dimer (Dimertest® [DDLx]) latex agglutination assay. DVT was considered present based upon VDU results only.

Results: DVT prevalence was 11.1%, and was higher with brain tumor (21.2%) and ICH (16%) than with TBI (6.7%) (² test; p = 0.001). DVT risk factors identified by multivariable logistic regression analysis in the overall sample included older age (p = 0.002), type of BI (p = 0.04), DDLx (p = 0.0001), and greater postinjury duration (p = 0.0001), with a trend observed regarding lower Functional Independence Measure (FIM) locomotion (FIM-Loco) subscale score (p = 0.07). However, risk factors also varied with type of BI. Among patients with TBI, only DDLx (p = 0.001) and greater postinjury duration (p = 0.001) were associated with DVT.

Conclusions: Admission venous duplex ultrasonography revealed occult proximal lower extremity deep vein thrombosis in 11% of neurorehabilitation patients with acquired brain injury. Deep vein thrombosis risk is multifactorial in this heterogenous patient population, with relative factor risk influenced by type of acquired brain injury. Semiquantitative D-dimer latex agglutination assay correlated significantly with presence of deep vein thrombosis.

Received January 7, 2004. Accepted in final form April 3, 2004.

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Neurology 2004 63: 408-409. [Full Text]  

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