Compression ultrasonography training program for ICU physicians does improve deep vein thrombosis risk management
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KeywordsDeep Vein Thrombosis Prospective Phase Thrombosis Risk Deep Vein Thrombosis Prophylaxis Compression Ultrasonography
ICU patients are a very high-risk population for deep vein thrombosis (DVT) and prophylaxis is often underused. This study was aimed to develop an educational program for ICU physicians to increase DVT prevention.
This study has been developed in two steps. By the retrospective one we assessed DVT incidence in patients admitted from December 2004 to December 2005 who were ≥ 18 years old and had been in the ICU longer than 72 hours. Exclusion criteria were DVT within the previous 6 months, thrombophilic profile, and high haemorrhagic risk. After this period all ICU physicians were trained to perform compression ultrasonography (CUS) for DVT screening; moreover, a DVT risk scoring form was introduced into the clinical practice. In the prospective phase we enrolled patients referred to the ICU from January 2007 to March 2008: inclusion and exclusion criteria were the same as the retrospective step. ICU physicians assessed the DVT risk, scoring daily for each patient, so as to prescribe the best DVT prophylaxis, and CUS screening was performed twice a week. Then we compared the two steps of the study.
During the prospective step we observed an increase in prophylaxis prescription: elastic stockings administration increased from 42.80% to 64.00% (P < 0.000) and the use of pneumatic compression devices increased from 3.17% to 4.90% (P = NS); low molecular weight heparin (U/kg) prescription did not change over the study periods. In the prospective phase the DVT incidence in the ICU was 4.5%, significantly lower than the 10.31% observed in the retrospective step (P < 0.05). This reduction was obtained in spite of the increase in the number of CUS screening for DVT: from 1.94 ± 1.38 CUS/patient (retrospective phase) to 2.42 ± 2.02 CUS/patient (P < 0.014).
ICU physician involvement in DVT risk management can be achieved through a training program to practice CUS screening and introduction of a DVT risk scoring form into the clinical practice. In our ICU these interventions were associated with a significant reduction in DVT incidence.
This article is published under license to BioMed Central Ltd.