TS03 *THE EFFICACY AND SAFETY OF PROPHYLACTIC VENA CAVA FILTERS AFTER MAJOR TRAUMA

Purpose: Despite increasing use of vena cava filters (VCFs) for pulmonary embolism (PE) prophylaxis after trauma, there is continued debate regarding their safety and efficacy. Methods: Prospectively collected data from The Alfred Hospital's trauma registry were used to identify all major trauma patients admitted between 1/7/2001 and 1/7/2008. These data were matched to data from the Department of Radiology's VCF Database. Results: 6,344 major trauma patients were treated during this period with 73.2% male, mean age of 44.2 ± 21.0 SD, 90.2% with a blunt mechanism of injury and mean ISS of 24.3 ± 12.0 SD. Of these patients, 511 (8.1%) received prophylactic VCFs (inserted in absence of PE) at the discretion of the treating clinician. There were 45 PE (0.71%), 2 of which were fatal. Three variables were independently associated with the occurrence of PE in a multivariate logistic regression model: presence of prophylactic VCF (OR 0.28; 95%CI 0.09–0.89); number of injuries to the AIS body region lower limb (OR 1.31; 95%CI 1.17–1.47) and central venous catheterization (OR 1.87; 95%CI 1.88–6.17). Data were available on the VCF database for 429 of the 511 patients with VCFs (84.0%). The mean time to prophylactic VCF insertion was 3.6 ± 0.2 SEM days after admission. The VCF major complication rate was 2.6% (n = 11), including 4 non-fatal PE. The technical success rate for retrieval was 92.4% (279 retrievals from 302 attempts) and the overall retrieval rate was 65.0% (279 retrievals from 429 placements). Conclusion: Prophylactic VCFs are associated with a reduced rate of PE when used in selected major trauma patients. In addition, prophylactic VCFs have a low major complication rate and high rate of technical success for retrieval.