Gersin K, Grindlinger GA, Lee V, Dennis RC, Wedel SK, Cachecho R.
The efficacy of sequential compression devices in mulitple trauma patients with
severe head injury.
J Trauma 1994 Aug;37(2):205-8

Boston University School of Medicine, Department of Surgery, MA 02118-2393.

Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma
Scale (GCS) score of 8 or less were prospectively studied to assess the
occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All
patients required mechanical ventilation. A sequential compression device (SCD)
was used in 14 patients and 18 patients received no prophylaxis for
thromboembolism. Bilateral lower extremity technetium venoscans and
ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission
and every week for 1 month or until the patient developed DVT or PE or was
discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at
16 and 28 days following trauma. Twenty-five patients had normal or low
probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary
arteriograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all
patients with a positive PAG. There were no differences in age, Injury Severity
Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who
developed DVT or PE and those who did not. A SCD was used in four of the eight
patients with DVT or PE. All but one patient with DVT or PE underwent placement
of a vena caval filter. Multiple trauma patients with severe head injury (GCS
score < or = 8) are at high risk for thromboembolism. The available means of
prevention and diagnosis of DVT or PE in multiple trauma patients with severe
head injury are not entirely effective.