naa a22 4500 510800297 CHVBK 20180411083352.0 cr unu---uuuuu 180411e20130401xx s 000 0 eng 10.1007/s12028-012-9786-x doi (NATIONALLICENCE)springer-10.1007/s12028-012-9786-x Safety of a DVT Chemoprophylaxis Protocol Following Traumatic Brain Injury: A Single Center Quality Improvement Initiative [Elektronische Daten] [Christopher Nickele, Timothy Kamps, Joshua Medow] Background: Venous thromboembolism (VTE) is a complication that affects approximately 30% of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU). Methods: Between January 1st and December 31st, 2009, consecutive patients discharged from the University of Wisconsin NSICU after>a 48h minimum stay were evaluated as part of a QI project. A protocol for the initiation of PTP was designed and implemented for NSICU patients. The protocol did not vary based on type of intracranial injury. The rate of VTE was reported as was heparin-induced thrombocytopenia and PTP-related expansion of intracranial hemorrhage (IH) requiring reoperation. The number of patients receiving PTP and the timing of therapy were tracked. Patients were excluded for persistent coagulopathy, other organ system bleeding (such as the gastrointestinal tract), or pregnancy. Faculty could opt out of the protocol without reason. Using the same criteria, patients discharged during the preceding 6 months, from July 1st to December 31st, 2008, were evaluated as controls as the PTP protocol was not in effect during this time. Results: During the control period, there were 48 head trauma admissions who met the inclusion criteria. In 22 patients (45.8%), PTP was initiated at an average of 4.9±5.4days after admission. During the protocol period, there were 87 head trauma admissions taken from 1,143 total NSICU stays who met criteria. In 63 patients (72.4%), the care team in the NSICU successfully initiated PTP, at an average of 3.4±2.8days after admission. All 87 trauma patients were analyzed, and the rate of clinically significant deep venous thrombosis (DVT) was 6.9% (6 of 87). Three protocol patients (3.45%) went to the operating room for surgery after the initiation of PTP; none of these patients had a measurable change in hemorrhage size on head CT. The change in percentage of patients receiving PTP was significantly increased by the protocol (p<0.0001); while the average days to first PTP dose trended down with institution of the protocol, this change was not statistically significant. Conclusion: A PTP protocol in the NSICU is useful in controlling the number of complications from DVT and pulmonary embolism while avoiding additional IH. This protocol, based on a published body of literature, allowed for VTE rates similar to published rates, while having no PTP-related hemorrhage expansion. The protocol significantly changed physician behavior, increasing the percentage of patients receiving PTP during their hospitalization; whether long-term patient outcomes are affected is a potential goal for future study. Springer Science+Business Media New York, 2012 Clinical protocols nationallicence Craniocerebral trauma nationallicence Intracranial hemorrhages nationallicence Prevention and control nationallicence Quality improvement nationallicence Venous thrombosis nationallicence Nickele Christopher Department of Neurologic Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, CSC K4/822, 53792, Madison, WI, USA aut Kamps Timothy Department of Quality Resources, University of Wisconsin, Madison, WI, USA aut Medow Joshua Department of Neurologic Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, CSC K4/822, 53792, Madison, WI, USA aut Neurocritical Care Humana Press Inc 18/2(2013-04-01), 184-192 1541-6933 18:2<184 2013 18 12028 https://doi.org/10.1007/s12028-012-9786-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9786-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Nickele Christopher Department of Neurologic Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, CSC K4/822, 53792, Madison, WI, USA aut NATIONALLICENCE 700 1- Kamps Timothy Department of Quality Resources, University of Wisconsin, Madison, WI, USA aut NATIONALLICENCE 700 1- Medow Joshua Department of Neurologic Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, CSC K4/822, 53792, Madison, WI, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/2(2013-04-01), 184-192 1541-6933 18:2<184 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer