MedicalResearch.com Interview with:
Alan Cook, MD, FACS
Director, Trauma Research Program
Chandler Regional Medical Center
Clinical Assistant Professor, Department of Surgery
University of Arizona College of Medicine – Phoenix
Chandler, AZ 85224 and
Frederick B. Rogers MD, MS, FACS
Lancaster General Health/Penn Medicine
Adjunct Professor of Surgery University of Pennsylvania College of Medicine
Department of Surgery
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The morbidity and mortality from pulmonary emboli (PE) are considerable. They range in severity from a problem amenable to outpatient medical management to fatal. Trauma patients are often ineligible for chemoprophylaxis due to the risk for life-threatening bleeding.
Yet traumatic injury can increase a person’s likelihood of having a pulmonary embolus via an array of mechanical and humoral pathways. The vena cava filter (VCF) offered the possibility of PE prophylaxis for patients otherwise vulnerable to PE risk. Use of VCF grew and the rate of use increased even more after the introduction of the retrievable VCF. Our study sought to determine if any temporal variation in VCF use has occurred and investigate if an contemporaneous change in the diagnosis of PE has taken place.
We used three databases to allow a telescoping window of observation from a single state, Pennsylvania (PTOS), to a convenience of sample of trauma centers across the country (NTDB), and finally a national, population-based sample of all hospital discharges in the US (NIS).
A temporal trend was observed in all three datasets with differing magnitudes and time points of change. The variation of vena cava filter use was most pronounced in the PTOS and least dramatic in the NIS, The rate of PE was essentially unchanged during the same period.
MedicalResearch.com: What should readers take away from your report?
Response: The pulmonary emboli rate did not change despite the decreased use of a prophylactic device. It should be kept in mind that vena cava filters are not intended to prevent all PEs, only the fatal ones.
Additionally, we found roughly half of the patients who did not receive a VCF had at least one published risk factor and between 7% to 15% of patients who received a VCF had no documented risk factors.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The need to identify which patient will benefit most from which mode of prophylaxis cannot be overstated. At the same time methods of prophylaxis continue to evolve, including the potential for completely new technologies. So along with better patient selection, work needs to be done to treat or prevent the disease by novel means.
MedicalResearch.com: Is there anything else you would like to add?
Response: Diagnostic accuracy has evolved substantially over the last two decades with every successive generation able to detect smaller and smaller pulmonary emboli. We did not have data pertaining to the method used to make the diagnosis of pulmonary emboli, though it would be interesting to include, given its role in the diagnostic process.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Cook AD, Gross BW, Osler TM, Rittenhouse KJ, Bradburn EH, Shackford SR, Rogers FB. Vena Cava Filter Use in Trauma and Rates of Pulmonary Embolism, 2003-2015. JAMA Surg. Published online May 10, 2017. doi:10.1001/jamasurg.2017.1018
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