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Deep venous thrombosis in patients with acute traumatic spinal cord injury: prevalence and patterns in a major teaching hospital in Uganda
Abstract
Background: Spinal cord injured patients are at high risk of developing Deep Venous Thrombosis (DVT). This is because spinal cord injury favours two of the Virchow’s triad of factors for DVT; thus endothelial injury (trauma) and immobility (venous stasis). DVT and Pulmonary Embolism (PE) have long been known to be a major health problem in the West. However, the problem in Africa has been underestimated due to lack of data.
Materials and methods: A cross sectional descriptive study was carried out at the spine unit of Mulago National Referral and Teaching Hospital from September 2012 to February 2013. Traumatic spinal cord injured patients who met the inclusion criteria were assessed for DVT using the model developed by Wells and colleagues. This included clinical assessment, D-dimer assay and Doppler sonography. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations.
Results: Out of 53 patients enrolled in the study, 48 were males and 5 were females. Most of the patients were in the age group of 21 to 40 years. DVT was found in 6 out of 53 patients representing 11.3%. All the patients who had DVT were in ASIA class A. There was bilateral involvement in one patient whereas two patients had thrombi in the left and three had thrombi in the right. A total of ten different thrombi were found, three proximal and seven distal. Clinical signs were found to be unreliable in the diagnosis of DVT in spinal cord injured patients. D-dimer test in combination with the Wells score was found to be a useful screening test and could reduce the need for further test if negative.
Conclusion: We found a prevalence of 11.3% in the spinal cord injured patients. This prevalence was comparable to studies done in Asia but within the lower border of studies done in Caucasians. Distal DVT was more common as opposed to Caucasians where proximal DVT is more common. Clinical features of DVT were found to be unreliable in spinal cord injured patients due to the neurological injury.
Keywords: Deep vein thrombosis, Pulmonary embolism, Traumatic spinal cord injury, Wells score, D-dimer assays, Doppler sonography
EAOJ; Vol. 7: September 2013
Materials and methods: A cross sectional descriptive study was carried out at the spine unit of Mulago National Referral and Teaching Hospital from September 2012 to February 2013. Traumatic spinal cord injured patients who met the inclusion criteria were assessed for DVT using the model developed by Wells and colleagues. This included clinical assessment, D-dimer assay and Doppler sonography. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations.
Results: Out of 53 patients enrolled in the study, 48 were males and 5 were females. Most of the patients were in the age group of 21 to 40 years. DVT was found in 6 out of 53 patients representing 11.3%. All the patients who had DVT were in ASIA class A. There was bilateral involvement in one patient whereas two patients had thrombi in the left and three had thrombi in the right. A total of ten different thrombi were found, three proximal and seven distal. Clinical signs were found to be unreliable in the diagnosis of DVT in spinal cord injured patients. D-dimer test in combination with the Wells score was found to be a useful screening test and could reduce the need for further test if negative.
Conclusion: We found a prevalence of 11.3% in the spinal cord injured patients. This prevalence was comparable to studies done in Asia but within the lower border of studies done in Caucasians. Distal DVT was more common as opposed to Caucasians where proximal DVT is more common. Clinical features of DVT were found to be unreliable in spinal cord injured patients due to the neurological injury.
Keywords: Deep vein thrombosis, Pulmonary embolism, Traumatic spinal cord injury, Wells score, D-dimer assays, Doppler sonography
EAOJ; Vol. 7: September 2013
