Cornwell EE 3rd, Chang D, Velmahos G, Jindal A, Baker D, Phillips J, Bonar J, Campbell K.
Compliance with sequential compression device prophylaxis in at-risk trauma
patients: a prospective analysis.
Am Surg. 2002 May;68(5):470-3.

Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287-5675, USA.
The Sequential Compression Device (SCD) is frequently the sole measure used
to prevent deep venous thrombosis (DVT) in trauma patients. The
purpose of this study was to evaluate the compliance with physician orders
for the application of SCD prophylaxis among nonambulatory trauma
patients at risk for DVT. We conducted a prospective
observational study at two Level I university-affiliated trauma centers.
Nonambulatory trauma patients were observed during their early postadmission
period in a non-critical care setting. Six observations
were made as to proper SCD applications during a 24-hour
period (two times in the morning shift, two in the evening
shift, and two overnight). "Full compliance" was defined as SCD on and
functioning properly in all six observations. In a total of 1343
observations in 227 patients only 42 patients (19%) were fully compliant.
The devices were on and functioning in 712 (53%)
observations. Among the 185 patients who were not fully compliant DVT risk
factors were common (83%) and adjunctive heparin prophylaxis was
infrequent (27%). The most common times for "noncompliant"
observations were early afternoon and midmorning. On multivariate analysis
only spinal column injury correlated with increased compliance.
In nearly half of the observations trauma patients at risk
for DVT were not receiving their SCD prophylaxis as per physician
orders. Fewer than 20 per cent of patients had the devices on
and functioning during each of the six observations during a 24-hour
period. These data point to the need for education of hospital
staff and for additional prophylactic measures in at-risk patients.