The Risk Assessment Profile is suboptimal for guiding duplex ultrasound surveillance in trauma patients

Abstract

Background: The utility of the Risk Assessment Profile (RAP) score in predicting VTE was assessed, and VTE risk factors identified to guide a duplex ultrasound (DUS) protocol in injured patients. Methods: Secondary analysis of prospective data on trauma inpatients (March 2017–September 2019), with admission RAP ≥5. Inhospital VTE patients compared to those without. Regression analyses in DVT, PE and proximal DVT, and ROC analysis evaluating RAP's VTE predictability were performed. Results: 1989 patients were analyzed. VTE was identified in 163(8.2%), DVT 159(8.0%), and PE 10(0.5%) patients. Strongest VTE predictors were massive transfusion (OR 5.97, p = 0.005) and spinal cord injury (OR 2.43, p = 0.03). AUC 0.61 (p < 0.001) on ROC analysis evaluating RAP on VTE. Abdominal injury and major surgery were unique risk factors to non-screened patients. Conclusion: Performance of RAP to predict VTE was moderate. VTE predictor variables could serve as the foundation for a novel approach guiding DUS surveillance. Derivation and validation are warranted.