期刊
JOURNAL OF SURGICAL RESEARCH
卷 216, 期 -, 页码 115-122出版社
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.jss.2017.04.033
关键词
Venous thromboembolism; Trauma; Age
类别
资金
- Patient-Centered Outcomes Research Institute (PCORI) titled Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology
- Agency for Healthcare Research and Quality titled Individualized Performance Feedback on Venous Thromboembolism Prevention Practice [1R01HS024547]
- National Institutes of Health/National Heart Lung and Blood Institute (NIH/NHLBI) entitled Analysis of the impact of missed doses of venous thromboembolism prophylaxis [R21HL129028]
- VHA
- Portola
- Daiichi-Sankyo
- Janssen
- Patient-Centered Outcomes Research Institute (PCORI) entitled Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department [AD-1306-03,980]
- Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant
- National Academies of Medicine titled Military Trauma Care's Learning Health System: The Importance of Data Driven Decision Making
Background: Venous thromboembolism (VTE) is a tremendous burden in health care. However, current guidelines lack recommendations regarding the prevention of VTE in older adult trauma patients. Furthermore, the appropriate method of modeling of age in VTE models is currently unclear. Methods: Patients included in the National Trauma Data Bank (NTDB) between the years 2008 and 2014 and patients included in the National Inpatient Sample (NIS) between 2009 and 2013 were analyzed. Multiple logistic regression of VTE on age was performed. Results: Of 3,598,881 patients in the NTDB, 34,202 (1.0%) were diagnosed with VTE compared to 5405 (1.1%) of the 505,231 patients in NIS. In both the fully adjusted NTDB and NIS model, age was positively associated with odds of VTE diagnosis under 65 years ( NTDB, adjusted odds ratio [aOR]: 1.018, 95% confidence interval [CI]: 1.017-1.019, P < 0.001; NIS, aOR: 1.025, 95% CI 1.022-1.027, P < 0.001). In patients aged >= 65 years, age was negatively associated with odds of VTE diagnosis in the NTDB ( aOR: 0.995, 95% CI: 0.992-0.999, P = 0.006) but not in the NIS (aOR: 0.998, 95% CI 0.994-1.002, P = 0.26). Conclusions: Incidence of VTE among adult trauma patients steadily increases with age until 65 years, after which the odds of VTE appear to level off or even slightly decrease. These findings should be applied for improved modeling of VTE in trauma patients. The mechanism behind these findings should be explored before using them to update guidelines for standardized VTE prevention in older adults. (C) 2017 Elsevier Inc. All rights reserved.
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