Article Text
PDF
Abstract
Introduction Patients with lower limb injuries are commonly discharged from the ED with the affected area immobilised. Rigid casting of the lower limb is known to be a risk factor for the development of venous thromboembolism (VTE), making thromboprophylaxis in this population an important consideration for clinicians in the ED. The use of structured risk assessment methods (RAMs) to evaluate VTE risk and recommend thromboprophylaxis to those at higher risk is widespread in the UK. However, the evidence informing this practice is nearly exclusively based on studies of patients with rigid lower limb casts but many patients with knee injuries, including some with significant thrombotic risk factors, are managed in semi-rigid (‘cricket’) knee splints. These are both removable and allow free movement of the ankle, but the baseline risk of VTE and the performance of different RAMs in this population are not known.
Methods Consecutive patients (≥14 years) discharged from the ED at Aberdeen Royal Infirmary, between 1 January 2010 and 31 December 2021, in a semi-rigid knee splint were identified retrospectively and followed up to 3 months after splint removal for the development of symptomatic VTE. Secondarily, data permitting the assessment of five different RAMs (NICE, GEMNet, an Aberdeen tool, the Plymouth score (V.2) and the L-TRiP(cast) score) were extracted systematically and compared.
Results In 510 patients (mean age 32 (SD 16) years, 62% male) none received thromboprophylaxis and all completed follow-up. Two patients developed symptomatic VTE (0.4%, 95% CI 0.1% to 1.4%). The different RAMs varied considerably in the proportions identified for thromboprophylaxis from GEMNet (47%) to the L-TRiP(cast) score (2%), but no RAM was able to identify the two patients who progressed to VTE.
Conclusions In our cohort of patients managed in semi-rigid removable knee splints, the risk of symptomatic VTE was low, about 1 in 250, and current methods of VTE risk assessment did not prove clinically useful.
- thromboembolic disease
Data availability statement
Data may be obtained from a third party and are not publicly available. Data held on NHS Grampian system.
Statistics from Altmetric.com
Data availability statement
Data may be obtained from a third party and are not publicly available. Data held on NHS Grampian system.
Footnotes
Handling editor Edward Carlton
Twitter @JamieCooperEM
Presented at Preliminary results were presented at the at The European Emergency Congress on Emergency Medicines, 8-12 September 2018, Glasgow, UK.
Contributors JGC conceived the study and its design. RH, AP and JGC acquired the data and performed the analysis. RH and JGC interpreted the data and drafted the manuscript. All authors reviewed the manuscript critically for intellectually important content and provided their final approval of the version to be submitted. All authors are accountable for the work.
Funding JGC is supported by NHS Research Scotland.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.