DVT Prophylaxis for Trauma Patients

Guideline · Nov 2018 · 2 min read

In brief

Clinical guideline for VTE risk assessment and prophylaxis in trauma patients aged 10-17 years. Defines risk categories (low, moderate, high) based on mobility status and additional risk factors, with corresponding prophylaxis recommendations using mechanical devices or pharmacologic agents within 24 hours of assessment.

All trauma patients aged 10-17 years require VTE risk assessment at admission and reassessment at 48-72 hours of hospitalization.
VTE prophylaxis should be initiated within 24 hours of risk assessment based on stratification: low, moderate, or high risk categories.
High-risk patients (altered mobility plus ≥2 risk factors) require both mechanical and pharmacologic prophylaxis unless contraindicated.
Consult surgery before starting pharmacologic prophylaxis in surgical patients to assess bleeding risk; use hematology for alternative agents.
Mechanical prophylaxis (SCDs/GCS) should be applied to both legs and used continuously except during ambulation or bathing.

Written by the GCMD Library team from the guideline.

Scope and Definitions

Establishes guideline applicability to trauma service patients at CCHMC and defines key terms including altered mobility, DVT, PE, and risk categories (low, moderate, high). Defines mechanical prophylaxis devices (graduated compression stockings and sequential compression devices) and clarifies venous thromboembolism terminology.

VTE Risk Assessment Requirements

Recommends systematic VTE risk factor assessment for patients aged 10-17 years at admission and reassessment at 48-72 hours of hospitalization. Risk stratification assigns patients to low, moderate, or high-risk categories based on presence of altered mobility and additional risk factors, with documentation required in the medical record.

Prophylaxis Implementation Timeline

Recommends initiating risk-appropriate VTE prophylaxis within 24 hours of assessment unless contraindications exist. Emphasizes early intervention while allowing clinical judgment for contraindicated cases.

Pharmacologic Prophylaxis Management

Requires surgical consultation regarding bleeding risk before initiating pharmacologic prophylaxis in surgical patients. Directs providers to institutional protocols (BESt #049) for LMWH management and mandates hematology consultation when considering alternative anticoagulant agents.

Risk Stratification Algorithm

References BESt 181 algorithm for detailed risk category assessment criteria and corresponding prophylaxis recommendations. Algorithm integrates patient-specific risk factors including altered mobility, trauma severity, surgical procedures, and comorbidities to guide mechanical and/or pharmacologic prophylaxis selection.

Statements in this guideline

Patients age 10–17 years should be assessed for VTE risk factors at the time of inpatient admission.
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VTE risk assessment should be repeated at 48–72 hours of hospitalization.
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VTE risk assessment and assigned risk category should be documented in the patient's medical record.
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VTE prophylaxis should be administered based on risk category as soon as feasible, but within 24 hours of assessment, unless there are contraindications.
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In surgical patients planning to receive pharmacologic prophylaxis, surgical input regarding bleeding risk should be obtained prior to initiation.
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Hematology consultation should be obtained when considering alternative pharmacologic agents for VTE prophylaxis.
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Low risk is defined as no VTE risk factors.
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Moderate risk is defined as multiple risk factors for VTE in the absence of altered mobility or altered mobility with one or fewer additional risk factors.
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High risk is defined as altered mobility plus two or more additional risk factors.
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Altered mobility is a permanent or temporary state in which the child has a limitation in independent, purposeful physical movement of the body or of one or more extremities.
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Full text

Guideline CCHMC Trauma Service Operation Guidelines Title: Venous Thromboembolism (VTE) Prophylaxis Effective Date: 06/2018 Number: TR-23 Page: 1 of 5 1.0 SCOPE 1.1 Care of the Trauma Services Patient at CCHMC. 2.0 DEFINITIONS 2.1. Altered mobility: A permanent or temporary state in which the child has a limitation in independent, purposeful physical movement of the body or of one or more extremities. 2.2. Deep Vein Thrombosis (DVT): A blood clot (thrombus) that was initially formed in a deep (non-peripheral) vein. 2.3. Graduated Compression Stocking (GCS): Elastic stockings, either knee- or thigh-high, also known as TED hose. 2.4. Risk category: Refer to VTE Risk Factors algorithm 2.4.1. Low risk: No VTE risk factors 2.4.2. Moderate risk: Multiple risk factors for VTE in the absence of altered mobility or has altered mobility with one or fewer additional risk factors. 2.4.3. High risk: Altered mobility plus two or more additional risk factors 2.5. Sequential Compression Device (SCD): A device designed to intermittently squeeze blood from underlying deep veins in the leg upon compression of an inflatable sleeve, and to allow the blood to flow again when it decompresses. 2.6. Venous Thromboembolism (VTE): A blood clot (thrombus) in a vein or one that has broken free and is carried in the bloodstream (embolus). 3.0 GUIDELINE 3.1. It is recommended that patients age 10 – 17 years be assessed for VTE risk factors, and based on that assessment, assigned to a risk category (low, moderate, high). 3.1.1. At the time of inpatient admission; and 3.1.2. Reassessed at 48 – 72 hours of hospitalization. 3.1.3. This should be documented in the patient’s medical record. 3.2. It is recommended that VTE prophylaxis be administered based on risk category as soon as feasible, but within 24 hours of assessment, unless there are contraindications (See algorithm). 3.3. If planning to initiate pharmacologic prophylaxis it is recommended: 3.3.1. In surgical patients to seek surgical input regarding bleeding risk prior to initiation 3.3.2. See BESt #049 for management of LMWH prophylaxis 3.3.3. Obtain Hematology consultation when considering alternative pharmacologic agents. 3.4. Refer to BESt 181 algorithm below for Risk Category Assessment and Prophylaxis for VTE.

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Venous Thromboembolism (VTE) Prophylaxis Page 5 of 5 4.0 REFERENCES 4.1 Multidisciplinary VTE Prophylaxis BESt Team, Cincinnati Children's Hospital Medical Center: Best Evidence Statement Venous Thromboembolism (VTE) Prophylaxis in Children and Adolescents, http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/bests/, BESt 181, pages 1-14, Date 2/18/14. 5.0 APPROVALS All revisions of this guideline are approved by the Trauma Service Department. This guideline is reviewed every three years or sooner if deemed necessary. Policy authority for this document resides with the Trauma Service Department. This guideline is approved by the Trauma Services Manager and the Director of Trauma Services. HISTORY Original Date 06/2004 Revision Date 05/15, 06/18 Review Date

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