Practice Variation in Vena Cava Filter Use Among Trauma Centers in the National Trauma Database.
J Surg Res
; 246: 145-152, 2020 02.
Article
en En
| MEDLINE
| ID: mdl-31580984
ABSTRACT
BACKGROUND:
Agreement regarding indications for vena cava filter (VCF) utilization in trauma patients has been in flux since the filter's introduction. As VCF technology and practice guidelines have evolved, the use of VCF in trauma patients has changed. This study examines variation in VCF placement among trauma centers. MATERIALS ANDMETHODS:
A retrospective study was performed using data from the National Trauma Data Bank (2005-2014). Trauma centers were grouped according to whether they placed VCFs during the study period (VCF+/VCF-). A multivariable probit regression model was fit to predict the number of VCFs used among the VCF+ centers (the expected [E] number of VCF per center). The ratio of observed VCF placement (O) to expected VCFs (OE) was computed and rank ordered to compare interfacility practice variation.RESULTS:
In total, 65,482 VCFs were placed by 448 centers. Twenty centers (4.3%) placed no VCFs. The greatest predictors of VCF placement were deep vein thrombosis, spinal cord paralysis, and major procedure. The strongest negative predictor of VCF placement was admission during the year 2014. Among the VCF+ centers, OE varied by nearly 500%. One hundred fifty centers had an OE greater than one. One hundred sixty-nine centers had an OE less than one.CONCLUSIONS:
Substantial variation in practice is present in VCF placement. This variation cannot be explained only by the characteristics of the patients treated at these centers but could be also due to conflicting guidelines, changing evidence, decreasing reimbursement rates, or the culture of trauma centers.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Centros Traumatológicos
/
Heridas y Lesiones
/
Pautas de la Práctica en Medicina
/
Filtros de Vena Cava
/
Utilización de Equipos y Suministros
Tipo de estudio:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Surg Res
Año:
2020
Tipo del documento:
Article