Objectives: The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) provides a guideline for when to initiate pharmacologic venous thromboembolism (VTE) prophylaxis in traumatic brain injury (TBI) patients. We hypothesized that implementation of the ACS TQIP-TBI guideline would not result in progression in intracranial hemorrhage.
Methods: The TBI TQIP guideline was implemented at a Level I Trauma Center. Patients with a stable CT of the brain after 24 hours or 72 hours were started on chemical prophylaxis with low molecular weight heparin or heparin. Computerized tomography (CT) scans after initiation of treatment were retrospectively reviewed by one board-certified radiologist to determine if there was progression of hemorrhage. Patients without a follow up CT scan were evaluated for progression of bleed/neurologic deterioration by review of physician notes, nursing documentation and Glasgow coma scale (GCS). Inclusion criteria for analysis included ≥ 18 years old, length of stay > 2 days, adherence to guideline, and non-pregnant patients.
Results: From July 2017 to December 2020, 12,922 patients were admitted to the trauma service. A total of 552 of these patients had TBI and 257 met inclusion criteria. A total of 43 patients had at least one CT of the brain after initiation of VTE prophylaxis. None of these 43 patients had progression of hemorrhage. 214 patients did not have a CT of the brain after VTE prophylaxis. Chart review showed that none of these patients had a clinical decline. Overall, there was no progression of hemorrhage in the 257 patients that met inclusion criteria.
Conclusion: Initiation of the TQIP TBI VTE prophylaxis guideline was found to be safe with no progression of intracranial hemorrhage.
