Intensivist performed compression ultrasound (IPCUS) for screening and early detection of deep venous thrombosis in trauma intensive care unit: a prospective study.

Introduction: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a critical complication in trauma patients, contributing to considerable morbidity and mortality. Multiple factors in trauma pose a challenge to the early initiation of VTE chemoprophylaxis, thereby underscoring the benefit of early detection strategies for DVT. This study evaluated the feasibility of intensivist-performed Compression Ultrasound (IPCUS) for screening of proximal lower limbs for DVT in the trauma intensive care unit (TICU).

Methods: We conducted a prospective study at a level 1 trauma center from November 2021 to May 2023 to assess the utility of IPCUS at the TICU. The study cohort included 800 multi-trauma patients aged 14 years and older admitted to trauma intensive care and step-down units. IPCUS was performed using a three-point compression technique at multiple post-injury time points. Positive or equivocal findings were validated by duplex ultrasonography (DUS). Patients were followed up for one month after discharge.

Results: The cohort was predominantly male (94.2%), with a mean injury severity score of 20. The overall incidence of VTE within the cohort was 3%. VTE chemoprophylaxis was administered to 60% of patients within the first 48 h. IPCUS identified DVT in 10 patients, with a sensitivity of 89% and specificity of 100%. There was no clinical evidence of missed proximal lower limb DVTs. There was a moderate agreement (Cohen's Kappa score of 0.46) between IPCUS and radiographer-performed DUS.

Conclusion: IPCUS is a feasible and effective screening method for proximal lower limb DVT in trauma patients with high diagnostic accuracy. Enhanced ultrasonography training for intensivists could further improve screening outcomes, reducing the number of equivocal cases. Larger studies are warranted to confirm these findings and establish standardized training protocols for IPCUS in trauma care settings.