The Utility of Lower Extremity Screening Duplex for the Detection of Deep Vein Thrombosis in Trauma.

BACKGROUND: Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. MATERIALS AND METHODS: A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. RESULTS: Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P = 0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P = 0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR = 1.48, 95% CI = 1.03-2.12). CONCLUSIONS: VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.

Large Gathering Attendance is Associated with Increased Odds of Contracting COVID-19: A Survey Based Study.

We used a telephone survey to determine risk factors associated with a positive polymerase chain reaction test of a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) at a community hospital in Central New Jersey during the early stages of the pandemic. We compared survey responses of 176 patients in March 2020. Respondents were asked about their living situation, work environment, use of public transportation and attendance at one or more large gatherings (more than 10 people) in the 3 weeks prior to undergoing COVID testing. We found that those who attended a large gathering in the 3 weeks prior to their COVID test had a 2.50 odds ratio (95% CI 1.19, 5.22) of testing positive after controlling for age, sex, race/ethnicity, occupation, living situation and recent visit to a nursing home. The total number of gatherings attended or the number of people in attendance was not associated with a positive test. An association was also seen for specific job types such as factory workers, construction workers, and facilities managers. Attendance at a gathering of more than ten people was associated with testing positive for COVID-19.