Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality

Restricted access

OBJECTIVE

Deep vein thrombosis (DVT) is a major focus of patient safety indicators and a common cause of morbidity and mortality. Many practices have employed lower-extremity screening ultrasonography in addition to chemoprophylaxis and the use of sequential compression devices in an effort to reduce poor outcomes. However, the role of screening in directly decreasing pulmonary emboli (PEs) and mortality is unclear. At the University of Mississippi Medical Center, a policy change provided the opportunity to compare independent groups: patients treated under a prior paradigm of weekly screening ultrasonography versus a post–policy change group in which weekly surveillance was no longer performed.

METHODS

A total of 2532 consecutive cases were reviewed, with a 4-month washout period around the time of the policy change. Criteria for inclusion were admission to the neurosurgical service or consultation for ≥ 72 hours and hospitalization for ≥ 72 hours. Patients with a known diagnosis of DVT on admission or previous inferior vena cava (IVC) filter placement were excluded. The primary outcome examined was the rate of PE diagnosis, with secondary outcomes of all-cause mortality at discharge, DVT diagnosis rate, and IVC filter placement rate. A p value < 0.05 was considered significant.

RESULTS

A total of 485 patients met the criteria for the pre–policy change group and 504 for the post–policy change group. Data are presented as screening (pre–policy change) versus no screening (post–policy change). There was no difference in the PE rate (2% in both groups, p = 0.72) or all-cause mortality at discharge (7% vs 6%, p = 0.49). There were significant differences in the lower-extremity DVT rate (10% vs 3%, p < 0.01) or IVC filter rate (6% vs 2%, p < 0.01).

CONCLUSIONS

Based on these data, screening Doppler ultrasound examinations, in conjunction with standard-of-practice techniques to prevent thromboembolism, do not appear to confer a benefit to patients. While the screening group had significantly higher rates of DVT diagnosis and IVC filter placement, the screening, additional diagnoses, and subsequent interventions did not appear to improve patient outcomes. Ultimately, this makes DVT screening difficult to justify.

ABBREVIATIONS BMI = body mass index; DVT = deep vein thrombosis; EVD = external ventricular drain; ICU = intensive care unit; IVC = inferior vena cava; LEDUS = lower-extremity Doppler ultrasonography; LOS = length of stay; PE = pulmonary embolus; UMMC = University of Mississippi Medical Center; VTE = venous thromboembolism.

Downloadable materials

  • Supplementary Tables 1 and 2 (PDF 421 KB)

Article Information

Correspondence Chad W. Washington: University of Mississippi Medical Center, Jackson, MS. cwashington4@umc.edu.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2018.12.JNS182800.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    The relationship between the time progression of PE diagnosis in patients treated with the routine-LEDUS policy (solid line) and those treated with the selective-LEDUS policy (dashed line). Comparison of the 2 groups (routine LEDUS vs selective LEDUS) showed no significant difference in the overall proportion of patients diagnosed with a PE or the time to PE diagnosis (e.g., the rate of PE in the selective-LEDUS group was not higher nor was their time to developing a PE any faster than in the routine-LEDUS group) (p = 0.432). Figure is available in color online only.

  • View in gallery

    The relationship between the time progression of IVC filter placement in patients treated with the routine-LEDUS policy (solid line) and those treated with the selective-LEDUS policy (dashed line). Comparison of the 2 groups showed a significantly higher proportion of patients in the routine-LEDUS group who had an IVC filter placed, with a significantly shorter time to placement than in the selective-LEDUS group (p = 0.0133). Figure is available in color online only.

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 287 287 43
Full Text Views 62 62 21
PDF Downloads 59 59 14
EPUB Downloads 0 0 0

PubMed

Google Scholar