Spain DA, Bergamini TM, Hoffmann JF, Carrillo EH, Richardson JD.
Comparison of sequential compression devices and foot pumps for prophylaxis of
deep venous thrombosis in high-risk trauma patients.
Am Surg 1998 Jun;64(6):522-5; discussion 525-6

Department of Surgery, University of Louisville, Kentucky 40292, USA.

Multiple-trauma patients are at increased risk for deep venous thrombosis (DVT)
but are also at increased risk of bleeding, and the use of heparin may be
contraindicated. Sequential pneumatic compression devices (SCDs) are an
alternative for DVT prophylaxis. However, lower extremity fracture or soft tissue
injury may preclude their use. In these circumstances, foot pumps (FPs) are often
substituted, yet little clinical data exist to support their use. We identified
184 consecutive high-risk trauma patients who received DVT prophylaxis with
compression devices. We reviewed demographic data, mechanism of injury, Injury
Severity Score, injury pattern, and method of prophylaxis. Generally, SCDs were
preferred, but FPs were substituted in patients with lower extremity injuries.
Occurrences of DVT or pulmonary embolism were also noted. Patients surviving less
than 48 hours were excluded. SCDs were used in 118 patients (64%) and FPs in 66
patients (34%). There were no differences in age, Injury Severity Score, or
presence of shock on admission. As expected, FP patients were more likely to have
lower extremity fractures (65 vs 26%; P < 0.05) and were also more likely to have
associated pelvic fracture (59 vs 25%; P < 0.05) and chest injury (61 vs 26%, P <
0.05). There was no difference in the incidence of head injury, although SCD
patients had more severe head injuries (Glasgow Coma Score, 7.9 vs 10.5; P <
0.05). The overall incidence of DVT was 5.4 per cent (10 of 184), with no
differences between the two groups (SCD 7% vs FP 3%). Three patients had a
pulmonary embolism (FP, two; SCD, one), none of which were fatal. Compression
devices provide adequate DVT prophylaxis with a low failure rate (3-8%) and no
device-related complications. FPs appear to be a reasonable alternative in the
high-risk trauma patient when lower extremity fractures precludes use of SCD.