Yaseen M Arabi1,2,3, Karen E A Burns4, Sami J Alsolamy5,6,7, Mohammed S Alshahrani8, Fahad M Al-Hameed9,10,11, Zia Arshad12, Mohammed Almaani13, Hassan Hawa14, Yasser Mandourah15, Ghaleb A Almekhlafi16, Abdulsalam Al Aithan17,18,19, Imran Khalid20, Jalal Rifai9,10,11, Gulam Rasool9,10,11, Sheryl Ann I Abdukahil5,6,7, Jesna Jose7,21, Lara Y Afesh7,22, Abdulaziz Al-Dawood5,6,7. 1. Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa. 2. King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa. 3. King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa. 4. Interdepartmental Division of Critical Care Medicine, Unity Health Toronto-St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada. 5. Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. 6. King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. 7. King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. 8. Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. 9. Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia. 10. King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia. 11. King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia. 12. Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India. 13. Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. 14. Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 15. Military Medical Services, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia. 16. Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. 17. Intensive Care Division, Department of Medicine, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia. 18. King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia. 19. King Abdullah International Medical Research Center, Al Ahsa, Kingdom of Saudi Arabia. 20. Critical Care Section, Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia. 21. Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. 22. Research Office, Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
Abstract
PURPOSE: We examined the association between surveillance for deep vein thrombosis (DVT) among medical-surgical critically ill patients by twice-weekly ultrasonography and 90-day all-cause mortality. METHODS: This was a pre-planned sub-study of the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (Clinicaltrials.gov: NCT02040103) that compared addition of intermittent pneumatic compression (IPC) to pharmacologic prophylaxis versus pharmacologic prophylaxis alone. The surveillance group included enrolled patients in the trial, while the non-surveillance group included eligible non-enrolled patients. Using logistic regression and Cox proportional hazards models, we examined the association of surveillance with the primary outcome of 90-day mortality. Secondary outcomes were DVT and pulmonary embolism (PE). RESULTS: The surveillance group consisted of 1682 patients and the non-surveillance group included 383 patients. Using Cox proportional hazards model with bootstrapping, surveillance was associated with a decrease in 90-day mortality (adjusted HR 0.75; 95% CI 0.57, 0.98). Surveillance was associated with earlier diagnosis of DVT [(median 4 days (IQR 2, 10) vs. 20 days (IQR 16, 22)] and PE [median 4 days (IQR 2.5, 5) vs. 7.5 days (IQR 6.1, 28.9)]. There was an increase in diagnosis of DVT (adjusted HR 5.49; 95% CI 2.92, 13.02) with no change in frequency in diagnosis of PE (adjusted HR 0.56; 95% CI 0.19, 1.91). CONCLUSIONS: Twice-weekly surveillance ultrasonography was associated with an increase in DVT detection, reduction in diagnostic testing for non-lower limb DVT and PE, earlier diagnosis of DVT and PE, and lower 90-day mortality. TRIAL REGISTRATION: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.
PURPOSE: We examined the association between surveillance for deep vein thrombosis (DVT) among medical-surgical critically ill patients by twice-weekly ultrasonography and 90-day all-cause mortality. METHODS: This was a pre-planned sub-study of the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (Clinicaltrials.gov: NCT02040103) that compared addition of intermittent pneumatic compression (IPC) to pharmacologic prophylaxis versus pharmacologic prophylaxis alone. The surveillance group included enrolled patients in the trial, while the non-surveillance group included eligible non-enrolled patients. Using logistic regression and Cox proportional hazards models, we examined the association of surveillance with the primary outcome of 90-day mortality. Secondary outcomes were DVT and pulmonary embolism (PE). RESULTS: The surveillance group consisted of 1682 patients and the non-surveillance group included 383 patients. Using Cox proportional hazards model with bootstrapping, surveillance was associated with a decrease in 90-day mortality (adjusted HR 0.75; 95% CI 0.57, 0.98). Surveillance was associated with earlier diagnosis of DVT [(median 4 days (IQR 2, 10) vs. 20 days (IQR 16, 22)] and PE [median 4 days (IQR 2.5, 5) vs. 7.5 days (IQR 6.1, 28.9)]. There was an increase in diagnosis of DVT (adjusted HR 5.49; 95% CI 2.92, 13.02) with no change in frequency in diagnosis of PE (adjusted HR 0.56; 95% CI 0.19, 1.91). CONCLUSIONS: Twice-weekly surveillance ultrasonography was associated with an increase in DVT detection, reduction in diagnostic testing for non-lower limb DVT and PE, earlier diagnosis of DVT and PE, and lower 90-day mortality. TRIAL REGISTRATION: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.
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