Surgery News - November 2007 - (Page 9)

NOVEMBER 2007 • SURGERY NEWS TRAUMA 9 Screening Variances Skew Interpretation of DVT Rates B Y J E F F E VA N S Else vier Global Medical Ne ws T he rate of deep vein thrombosis reported by a trauma center may be a poor way to measure quality of care, considering the lack of consensus in screening for the condition with duplex ultrasound, according to investigators from Johns Hopkins University, Baltimore. The rate of deep vein thromboses (DVTs) after major trauma is used by the U.S. Agency for Healthcare Research and Quality as a hospital-level patient safety indicator and by the Joint Commission as a quality of care measure. But there are no recommendations for a standardized approach to DVT surveillance, and screening of asymptomatic patients varies widely, according to the researchers. They presented their study at the annual meeting of the American Association for the Surgery of Trauma. Some believe that high-risk, asymptomatic trauma patients should be screened for DVT, whereas others contend that it is not cost effective. Practitioners and hos- sion model that controlled for trauma center level and teaching status. But the DVT rate significantly increased when the surveillance rate increased in trauma centers with a duplex ultrasound rate of 2% or more. The study of hospital-level data did not control for patient factors such as injury severity, age, race, or gender, and the screening procedures of individual trauma centers were not known, although the researchers plan to use patient-level data in a future analysis. Previously, Dr. Haut and his colleagues found that rates of DVT screening with duplex ultrasound at the level I trauma center of Johns Hopkins Hospital increased significantly after implementation of a DVT screening guideline. The rates rose from 0.7 to 7 per 1,000 trauma admissions. Surveillance bias probably affects the DVT rate more than other common complications that follow trauma—pneumonia, urinary tract infection, acute respiratory distress syndrome, and myocardial infarction—because of the variability in screening practices for DVT, according to Dr. Haut. The DVT rate at hospitals may have as much to do with the frequency of screening as all other factors combined. In fact, it may be better to measure trauma care quality according to the frequency of duplex ultrasound screening, the process of care, or how a trauma service is structured, rather than on the basis of an outcome like DVT rate, Dr. Haut suggested. ■ ‘HIGHER DVT RATES MAY NOT BE A MARKER OF QUALITY OF CARE, BUT RATHER AN OUTCOME OF IMPROVED SCREENING PRACTICES.’ pitals that screen more aggressively for DVTs with duplex ultrasound may identify more cases of DVT and appear to provide worse quality of care than practices that screen less often, said study investigator Dr. Elliott R. Haut in an interview. “Higher DVT rates may not be a marker of quality of care, but rather an outcome of improved screening practices,” he said. Its use as a quality measure may provide biased results and may misinform its users unless the patient population, frequency, and methods for screening are standardized. In a simple linear regression analysis of the rates of DVT and duplex ultrasound screening at 147 hospitals reported in the National Trauma Data Bank as having at least one complication and performing at least one duplex ultrasound, the investigators found that for every 1% increase in the rate of duplex ultrasound, there was about a 1% increase in the DVT rate. The quartile of hospitals that performed the most duplex ultrasound scans (5-25 per 100 patients) had the highest DVT rate (1.5 per 100 patients). In contrast, the quartile that performed the fewest scans (0.01-0.17 per 100 patients) had the lowest DVT rate (0.27 per 100 patients). “The more you look, the more you find,” said Dr. Haut, of the division of trauma surgery and critical care at Johns Hopkins. Increases in the rate of duplex ultrasound surveillance did not significantly change the DVT rate at trauma centers with a duplex ultrasound rate of less than 2%, according to a multiple linear regres- ON-Q® labeled for enhanced pain relief indications Continuous, automatic flow of local anesthetic post-op delivers: • Significantly better pain relief than narcotics • Significantly less need for narcotics Outcomes validated in landmark pain relief study published in The Journal of the American College of Surgeons* Better patient outcomes across surgical specialties—gets patients on their feet faster BREAKING NEWS ON-Q infection prevention study results presented† Post-op data from a colorectal surgery study showed that use of the ON-Q® PainBuster® with ON-Q® SilverSoaker™ resulted in: • Surgical site infection rates more than halved (6.6% vs 14.6% for control group, n=289) • Hospital stays reduced by 2.3 days (6.1 days vs 8.4 days) More information is available at www.iflo.com. *Liu SS, Richman JM, Thirlby RC, Wu CL. Efﬁcacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized clinical trials. J Am Coll Surg. 2006;203:914-932. † Singh J, Hum M, Cohen S, et al; and the MISS Study Group. Multicenter infection surveillance study comparing two types of postoperative pain management, surgical site using ON-Q® SilverSoaker™ and local anesthetics vs. systemic narcotics following colorectal procedures. Paper presented at: 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 2007; Chicago IL. ON-Q is not labeled for reducing infection rates and is not intended as a treatment for existing infections. Rx Only. For a list of supporting studies, please visit www.iﬂo.com. As a physician, you are aware that risks are inherent in all medical devices. 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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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