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December 23, 2005
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Rohit Sahai, M.D.1, Dave Pillus, M.D.2, Valerie Myers, M.D.2, Michael Makaroun, M.D.2, Nav Y. Gupta, M.D.1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA.
Objective: Patients in the neuro-intensive care unit (NICU) are believed to be at high risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Aggressive strategies for early detection in these patients, such as routine surveillance duplex studies, might be able to identify patients with DVT’s and prevent PE’s. We report on a prospective study of the utility of surveillance duplex scans in NICU patients at our institution.
Methods: A protocol for surveillance duplex studies was put into effect in 10/04. We prospectively followed patients that had been in the NICU for 7 days or a multiple thereof with scans. Any patient with suspicion of having a DVT by the primary or ICU team could receive a scan at any time.
Results: Of 158 patients, the leading reasons for admission to the NICU were hemorrhagic stroke (47.5%) ischemic stroke (16.5%), and tumors (11.4%). Most patients (91.1%) had some form of DVT prophylaxis. These 158 patients received a total of 223 duplex scans over 11 months. Twelve patients (7.6%) were found to have DVT’s. Only 6 (3.8%) however were asymptomatic from their DVT’s. PE’s occurred in 6 patients (3.3%). Only 1 patient had a PE presumably due to an asymptomatic DVT found by duplex (0.6%).
Conclusions: The rate of asymptomatic DVT’s in NICU patients is low. In addition, there was only one PE and no PE-related deaths from asymptomatic DVT’s. The risk benefit ratio in this patient population should be carefully considered prior to instituting a routine surveillance regimen for DVT.
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Is Routine DVT Surveillance Justified in the Neuro-Intensive Care Unit?
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Rohit Sahai, M.D.1, Dave Pillus, M.D.2, Valerie Myers, M.D.2, Michael Makaroun, M.D.2, Nav Y. Gupta, M.D.1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA.
Objective: Patients in the neuro-intensive care unit (NICU) are believed to be at high risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Aggressive strategies for early detection in these patients, such as routine surveillance duplex studies, might be able to identify patients with DVT’s and prevent PE’s. We report on a prospective study of the utility of surveillance duplex scans in NICU patients at our institution.
Methods: A protocol for surveillance duplex studies was put into effect in 10/04. We prospectively followed patients that had been in the NICU for 7 days or a multiple thereof with scans. Any patient with suspicion of having a DVT by the primary or ICU team could receive a scan at any time.
Results: Of 158 patients, the leading reasons for admission to the NICU were hemorrhagic stroke (47.5%) ischemic stroke (16.5%), and tumors (11.4%). Most patients (91.1%) had some form of DVT prophylaxis. These 158 patients received a total of 223 duplex scans over 11 months. Twelve patients (7.6%) were found to have DVT’s. Only 6 (3.8%) however were asymptomatic from their DVT’s. PE’s occurred in 6 patients (3.3%). Only 1 patient had a PE presumably due to an asymptomatic DVT found by duplex (0.6%).
Conclusions: The rate of asymptomatic DVT’s in NICU patients is low. In addition, there was only one PE and no PE-related deaths from asymptomatic DVT’s. The risk benefit ratio in this patient population should be carefully considered prior to instituting a routine surveillance regimen for DVT.
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