Compliance with venous thromboembolism chemoprophylaxis guidelines in non-operative traumatic brain injury

Jacques Lara-Reyna, Lea Alali, Raymond Wedderburn, Konstantinos Margetis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the level of compliance of The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) for initiation of venous thromboembolism (VTE) prophylaxis after non-operative traumatic brain injury (TBI) and the explanation for the deviations. Methods: A retrospective review from May 2018 to February 2020 in a Level II trauma center for patients with TBI and length of stay of more than 24 h. We performed an analysis of overall and subgroup compliance with guidelines. The ACS TQIP criteria for low and moderate-risk for hemorrhagic progression were used for subgroup classification. Results: Of 393 patients, 239 (60.8%) patients received chemoprophylaxis in a mean of 64 (SD: +/−42) hours since admission. “Compliance” was achieved in 52.2% of patients. In subgroup analysis, 51.4% of patients in “low-risk” and 55.1% in “moderate-risk” were “compliant.” The most common rationale for non-compliance in “low-risk” was a stay less than 48 h in 35.9% of patients. However, in “moderate-risk,” the most common non-compliance was starting prophylaxis before the recommended 72 h from admission in 37% of cases. Conclusions: Guidelines streamline clinical practice to optimize outcomes, but there are scenarios in which deviation of the recommendations may be indicated based on clinical judgment. We show that a stay of less than 48 h was the most common rationale for not starting prophylaxis in “low-risk” patients. However, in the “moderate-risk” subgroup, the most common reason was starting chemoprophylaxis before the recommended time frame, which we called a “paradoxical” non-compliance.

Original languageEnglish
Article number107212
JournalClinical Neurology and Neurosurgery
Volume215
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • Guidelines
  • Prophylaxis
  • Traumatic brain injury
  • Venous thromboembolism

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